1. Extracorporeal Membrane Oxygenation
Definition
Cardiopulmonary Bypass
Pulmonary support
Cardiac support
Outcomes
International
CCHMC

2. Indications Meconium Aspiration Syndrome
Persistent Pulmonary Hypertention of the Newborn
Sepsis/pneumonia
Respiratory Distress Syndrome
Congenital Diaphragmatic Hernia
Congenital Heart Disease

3. Criteria Weight greater than 1.8-2 kilograms
At least 34 weeks gestation
Less than 7 days mechanical ventilation
IVH less than grade II
Failure of maximal medical management
Potentially reversible lung disease

4. Personnel ECMO Team Hospital Services Attending Fellows
Patient care provider
ECMO specialist
ECMO primer
Hospital Services
Ultrasound
Cardiology
Nephrology
Neurology
Operating room staff

5. Circuit Layout

6. Process Cannula Placement ECMO flows Heparinization
Veno-arterial
Veno-venous
ECMO flows
Heparinization
Activated Clotting Time
Blood Products
Respiratory Support

7. ECMO Cart

8. Bladder Box

9. Cobe Pump

10. Membrane Oxygenator

11. Heat Exchanger

12. CDI

13. Roles Patient Care Provider ECMO Specialist ECMO Primer
RN who cares for the patient
ECMO Specialist
RN or RRT who has received special education
Responsible for the ECMO machine and management
ECMO Primer
ECMO specialist who has received further training and is able to prepare the ECMO circuit

14. Before going on ECMO Draw labs - includes type and cross
Order blood products
Obtain consent from family
Prepare ECMO circuit (ECMO Primer)
Draw up code drugs
IV Access

15. During Cannulation
Administer meds as ordered for pain/sedation/paralysis
Monitor the patient as you would for any bedside surgical procedure
Frequent vital signs - especially blood pressure (may need to give volume)
Have access to a stable IV site. You will be asked to give the loading dose of Heparin at some point during the surgery.
Obtain CXR once cannulas are placed

16. During Run Switch all IV drips to ECMO circuit CVC Care
Medication/blood product administration
Double check everything with the ECMO specialist.
Cannula site care. Done Q4hrs.
Wash site with 1/2 strength H2O2,
Apply betadine ointment
Cover with sterile 4x3.
Physical care of the patient
Lab draws

17. Decannulation
Obtain IV access if needed. Move all drips to the patient before clamping.
Draw up code drugs
Will continue the Heparin drip until the final decision has been made to decannulate.
Obtain consent for decannulation.
Give meds for pain/sedation/paralysis
Usually continue Cannula site care for 24 hours after coming off ECMO

18. Emergency Care
If the patient needs to be removed emergently from ECMO due to mechanical failure, there are several things you can do. You should have been shown how to take the patient off ECMO using V-B-A. Clamp the Venous cannula, open the Bridge, clamp the Arterial cannula.
Call for assistance.
Manage the patient, You will need to ventilate (increase vent support or handbag). Administer meds/fluids as needed.
Have someone available to get needed supplies.

19. Complications Bleeding/Hemorrhage Reperfusion injuries
Inability to wean
Mechanical failure
Electrolyte Imbalance
Edema
Renal Failure
Hypovolemia
Hypertension