SKGK – Session 19 – Topic: ECMO (Answers) – Date: 25 April 2017

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1⃣ ECMO stands for Extracorporeal
Membrane oxygenation.

2⃣  It is used for the patient either suffering from heart failure and lung failure.

It acts as a cardiac and respiratory support.

3⃣ Principle….

Effective oxygenation is obtained when oxygen and blood are running in opposite direction through a thin porous membrane.

4⃣ Modes….

1. Veno- venous support ( VV)

The blood is returned to the venous system.

2. Veno-arterial support (VA)

The blood is returned to the arterial system.

5⃣  Parts of ECMO _

1. Mechanical blood pump – pumps the blood into the arterial system or venous system depending on the mode.

2. Gas exchange devices- performs the transfer of Oxygen inside and whereas  carbon dioxide outside through the porous membrane.

3. Heat exchanger- controls the thermodynamics of the blood outside the body.

Monitors- integrated with flow meter in order to measure the flow of blood.

6⃣ Difference—

The main difference between ECMO and CPB is essentially the purpose and time..

1. The ECMO can be attached to the patient for days who are suffering from disorders related to heart or lung.

2. The CPB or heart lung machine can be attached to the patient for some hours undergoing the cardiac procedure namely Open heart surgery.

7⃣ Advantages of ECMO —

1. It can maintain the supply of oxygen to the body during the lung failure.

2. ECMO does a little heal in underlying conditions.

8⃣ It can be used for patient from one day  to max. 2 weeks.

9⃣ 1. Pump chatter–

The pump rattling or chatter which is due to the pressure between the volume and the motor.

Fix- temporarily lower the RPMs until chattering is minimized.
Usually administration of 500-1000ml of volume de jour will fix the problem.

2. Circuit and oxygenator changes–

These are commonly required for aged ckts (2-3 weeks) where clot accumulation can form agglutination.

🔟 Improvement–

To make membranous oxygenators more reliable and more efficient

1⃣1⃣ Sir Robert Bartlett started the work for ECMO in his laboratory in 1960s.

A baby named Esperanza was survived the lung disease through ECMO in 1976.

An organization named ECMO Life organization was started in 1989 by Robert Bartlett.
_______________________

Yash Gajanan Tiknayat
Final year Biomedical
D.B.N.C.O.E.T., India

yashtiknayat2012@gmail.com

Have a good day.
Thank you!! 😊😊

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1. ECMO : Extracorporeal membrane oxygenation machine.

2. Used for providing both cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life.

4. There are three modes of ECMO: Veno-Venous (VV), Veno-Arterial (VA) and Veno-Pulmonary Artery (V-PA).

5. Parts are :1. cannulae: large catheters (tubes) inserted into the blood vessels to remove and return blood
2. membrane oxygenator: an artificial lung that oxygenates the blood.
3. warmer and filter: machinery that warms and filters the blood before the cannulae return it to the body.

6. ECMO is used for long term support to allow recovery of the lungs and/or heart.
CPB ( cardio pulmonary bypass) is used for a matter of hours to provide support during cardiac procedures.

7. Advantages : pulmonary oxygenation is maintained . Efficient co2 is removed.

8. A person can be on ecmo from several days up to 1-2 weeks.

11. In 1975, Bartlett et al. reported the first successful use of ECMO in neonates with severe respiratory distress.  According to the Extracorporeal Life Support Organization (ESLO) registry, ECMO was used in over 5,000 cases in 2014 .

Nishita ghariwala, student.
Gujarat, India.
nghariwala@gmail.com

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1⃣
Extra Corporal Membrane Oxygenation

2⃣
To provide both cardiac and respiratory support to the ones who are unable to provide adequate gas exchange.

3⃣
Uses membrane oxygenators for oxygenation of blood which provides long term use unlike bubble oxygenators.

4⃣
veno-venous (VV) ECMO: VV ECMO takes blood from a vein and returns it to a vein. This type of ECMO supports lung function.

veno-arterial (VA) ECMO: VA ECMO takes blood from a vein and returns it to an artery. VA ECMO supports both the heart and the lungs.

5⃣
cannulae: large catheters (tubes) inserted into the blood vessels to remove and returnblood membrane

oxygenator: an artificial lung that oxygenates the
blood

warmer and filter: machinery that warms and filters the blood before the cannulae return it to the body

6⃣
CPB is used mostly during OHS to provide a still environment without blood flow to perform surgery by taking up function of heart and lungs while *ECMO is used mostly after surgery to help heart and lungs to recover.

7⃣
-Main advantage of ECMO machine is that it can maintain the supply of oxygen to body while testing the lungs.
-the pumping ability of ECMO machine can also provide support for reversible heart disorders.

8⃣
Often patient will be on ECMO for several days upto 1-2 weeks.

9⃣
1. Pump Chatter
Chatter, or rattling, of the circuit and ECLS lines and can occur at any time after the pump is running.
Fix: temporarily lower the RPMs until chattering is minimized.
2. Differential Hypoxemia during VA ECMO
Fix: One solution is to place a venous return catheter in the IJ to allow oxygenated blood to flow through the heart (VAV ECMO).

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