Download presentation
Presentation is loading. Please wait.
1
Presented by Nai-Hsin Chi National Taiwan University Hospital
ECMO extracorporeal membrane oxygenation extracorporal life support /9/22 Presented by Nai-Hsin Chi National Taiwan University Hospital
3
ECMO prolonged partial cardiopulmonary bypass
4
ECMO vs CPB reservoir
8
CPB vs ECMO Yes Yes in high flow
9
composite of ECMO Blood pump centrifugal pump membrane oxygenator
roller pump+ control-bladder membrane oxygenator hollow fiber oxygenator silicone membrane oxygenator Heater
10
ECMO 機器
11
ECMO主機
13
Centrifugal pump
14
滾輪式幫浦加囊狀控制裝置
16
Pig-Tail 排氣用 接氧氣
17
Cannula
18
Arterial cannula
19
MX-2 monitor
20
氣體流量表
21
ECMO Short-term cardiopulmonary support 1-2 weeks
Bridge to decision Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,..) Give-up
22
for lung 1. support : O2 supply & CO2 removal
2. rest : reduce ventilator induced lung injury
23
for heart support : improve systemic perfusion rest :
↓catecholamine ↓myocardial work decrease preload requirement and congestion
24
ECMO Type VV - ECMO VA - ECMO
26
VV-ECMO indication : for lung disease only
purpose : to decrease barotrauma ventilator setting : PC mode, PEEP >10 , PIP < 35 , VR --> PaCO2, FiO2--> PaO2
28
VA-ECMO advantage : 1. both lung & heart support
29
Application of ECMO As a mechanical circulatory support:
Post-cardiotomy cardiogenic shock Double bridge (ECMO VAD HTx) Acute myocarditis AMI cardiogenic shock (ECPR) Rescue for acute pulmonary embolism Ventilatory support ARDS Neonatal pulmonary diseases
34
Different patients Different situation Different treatment t
35
ECMO in NTUH 1994 Aug. 11 2003 Dec. 31
41
ECMO工作車 All you need to set up ECMO Put everything on the wheel Then,
OR, ICU, cath room, ES, ward, etc
42
Bleeding Anticoagulation Thrombus
45
尿紅
49
Five-Year Results of 219 Consecutive Patients Treated With Extracorporeal Membrane Oxygenation for Refractory Postoperative Cardiogenic Shock Ann Thorac Surg 2004; 77:151-7
50
Results Mortality Cause : 86 (39%) did not improved and weaning
133 (61%) successfully weaned from ECMO Mortality Cause : Refractory myocardial failure : 118(71%) MoF : 24(14%) Cerebral infarction/bleeding : 8(5%) Sepsis : 6(4%) ARDS: 4(2.5%) DIC : 2(1%) Bowel ischemia : 2(1%) Pulmonary embolism: 2(1%) ET tube into esophagus : 1(0.5%) 52 (39%) discharge Mean hospital stay: 29.924 days
51
Bridge VAD : 8 Transplant : 4 survival HeartMart : 2
Heart Transplant : Survival Berlin Heart : 6 (Biventricular : 4, Univentricular : 2) Successfully weaning : 1 Die : 5
52
ECMO Short-term cardiopulmonary support 1-2 weeks
Bridge to decision Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,..) Give-up
53
ECMO Advantage: Both children & adult (wide range of BW)
Flexible cannulation site: femoral, neck, chest Higher support Rapid & easy set-up & remoral Disadvantage: Bleeding Bedridden Infection SIRS Labor-intensive Partial CP support
54
Thank you
Similar presentations
