2. ECMO AT THE U of M Two era’s 1974 & 1986 1974 - 12 patients. Kolobow Membrane Lung – Roller Pump – Adult and Peds. Patients. No Survivors 1986 to present - ? Patients. Several different oxygenators, Centrifugal pump only! ?% overall survival

8. CIRCIUTS FOR ECMO ARTERIAL VENOUS VENOVENOUS PERIPHERAL CENTRAL (OPEN CHEST)

11. CANNULATION TECHNIQUE NEONATE PERIPHERAL Neck cannulation Positioning of patient Sedation Surgical Prep Ideal Cannulae Position

16. Ideal Arterial Cannula Placement A V ECMO Cannula in Ascending Aorta just above Aortic valve (adjacent coronary ostia) Supplies oxygenated blood to coronaries and the rest of the circulation. Cannula tip should avoid proximity with the Aortic valve leaflets and stay out of left ventricle.

22. SINGLE CANNULA VENOVENOUS Dual luman cannula Smallest size 14 fr. - limits use to patients above 4 kg. 15 Fr. – 4kg to < 9kg two lenghts Flow recirculation 15-30% Requires higher flows No lung rest - must ventilate Requires good cardiac function

26. VENEO/VENOUS IN ADULTS Peripheral cannulation Drainage from Femoral vein Return SVC via Jugular access (Or visa versa) Access may be percutanious or direct cut down Percutanious is better (less bleeding) Requires ventilation (no lung rest) Requires good cardiac function

27. VENO/ARTERIAL ADULTS Peripheral -Femoral vein, Femoral Artery –Limited distribution of blood centrally –Must have reversal of flow in Aorta for oxygenated blood to reach Heart and Brain –Must place distal perfusion cannula in Femoral artery Central cannulation - Aorta, Rt. Atrium –Complete cardiopulmonary support