1. ECMO Extracorporeal membrane oxygenation
YOUSSEF DSOUKI
SENIOR PERFUSIONIST
LAUMC

2. What’s ECMO
Support of heart and /or lung with a mechanical device which :
restores oxygen delivery .
Is temporary .
Avoids ongoing iatrogenic injury .
sustains life while bridging to decision,organ recovery or replacement .

4. ECMO Indications
Acute severe cardiac or pulmonary failure unresponsive to optimal management with expected recovery or potential for organ replacement .

5. TYPES Veno arterial ( VA ) Veno venous ( VV )
In both modalities , blood drained from the venous system is oxygenated outside of the body,this blood is returned to the arterial system in the VA and in the other system blood is returned to the venous side .in VV ECMO no cardiac support is provided .

9. Cannulation
Cannulae are usually placed percutaneously by the Seldinger technique by cardiac surgeons,interventional cardiologists,intensivits, emergency physicians .
In complicated case only surgeons authorized to cannulate by the surgical way .
Following cannulation ,the patient is connected to the ECMO circuit and the blood flow is increased until respiratory and hemodynamics status is stable .

11. Indications Hypoxemic respiratory failure .
Hypercapnic respiratory failure with an arterial PH lower than 7,2 .
Refractory cardiogenic shocks .
Cardiac arrest .
Failure to wean from cardiopulmonary bypass after cardiac surgery .
As a bridge to either cardiac transplantation or placement of a ventricular assist device .

14. Establishing an ECMO program at our Hospital
Key players :
Cardio thoracic surgery .
OR Administrator .
Nursing : OR RN , ICU RN , CSU RN .
Perfusionists .
Hospital administration .

15. Training 12 hours of training per RN .
RN must be able to establish his material within 10 min .
Direct wet loop training in the ICU and CSU unit .
Manage a real live patient .
ongoing competency evaluation every other month to maintain skills .

16. Innovation ECMO New oxygenator solid hollow fiber Low pressure blood
Portable
Preventing ICU syndrome

17. Report Case
Girl of 21 years old present to the ER service, took 20 pills of digoxine, as a trial of suicide.
Digoxine affects the heart, an overdose can lead to a heart arrest .
Usually in overdose cases a gastric lavage is sufficient , but in case of digoxine the effect in the heart is irreversible .
The decision of the implementation of ECMO system was taken quickly .
One week after stabilization , ECMO was removed , and the patient’s health improved .

18. Report Case
24 years old a patient present to the ER service ,for a multi trauma injury due to a motorcycle accident .
20 minutes later of treatment , patient had a first cardiac shock , after CPR he retrieved his heart function , the indication of implementation of ECMO was taken to stabilize him .
patient undergone several surgeries and one week later ECMO was removed and the patient’s health improved .

20. Report Case
37 years old a patient present to ER service after 4 days of high fever , with difficulty of respiration .
He was admitted in the ICU, the diagnostic of H1N1 was confirmed .
patient was intubated , with high pressure of ventilation no response was shown .
the decision of implementation of ECMO was taken .
the strategy included putting lungs with no mechanical ventilation .
2 weeks later patient was cured and ECMO was removed .

24. Famous report case
Brandon Marshall remained at North Western Memorial Hospital on friday with a lung injury after a big shock with another player on NFL Championship .
Brandon was intubated before his transfer to the hospital , but the problem of mechanical ventilation will make his case worse .
the decision of implementation an ECMO system was taken .
After 3 weeks of treatment with regular fibroscopy and bronchoscopy , his lung was cured , ECMO was removed .
Brandon integrated the League and Won the championship one year later .

27. ECMO conclusions Is possible with minimal complications .
Can be life saving in severe heart or lung failure.
Prevents ongoing iatrogenic injury.
Heart and lung rest is better than extremes of other management .
Technology and experience has improved safety.
Earlier is better .
Patient selection is key to success .