ECMOECMO

Extra Corporeal Extra Corporeal Membrane OxygenationMembrane Oxygenation

ECMO IndicationsECMO Indications

Acute, reversible lung and/or cardiac Acute, reversible lung and/or cardiac failure that is unresponsive to failure that is unresponsive to conventional therapiesconventional therapies

Gestational age: 34 weeks or >Gestational age: 34 weeks or > Weight: 2000 grams or >Weight: 2000 grams or > Predicted mortality: 80% or >Predicted mortality: 80% or >

A-a gradient (on 100% FIO2): 620 mmhg or >A-a gradient (on 100% FIO2): 620 mmhg or > Oxygen Index (OI): 40 or >Oxygen Index (OI): 40 or >

OI = OI = (MAP x FIO2(MAP x FIO2) x 100) x 100 PaO2PaO2

ECMO TechniquesECMO Techniques

VenoarterialVenoarterial Complete Complete

cardiopulmonary cardiopulmonary bypassbypass

Out: Right atrium via Out: Right atrium via internal jugularinternal jugular

In: Aortic arch via In: Aortic arch via carotidcarotid

Requires ligation of Requires ligation of one carotid artery!one carotid artery!

ECMO Techniques (ECMO Techniques (concont.)t.)

VenovenousVenovenous Out: right atrium via internal jugularOut: right atrium via internal jugular In: right atrium via femoral veinIn: right atrium via femoral vein

Is a lung bypass only techniqueIs a lung bypass only technique No ligation of carotid arteryNo ligation of carotid artery Newer circuits have a dual lumen Newer circuits have a dual lumen

catheter so in/out is in right atrium catheter so in/out is in right atrium via one vein onlyvia one vein only

ECMO CircuitECMO Circuit

ECMO ManagementECMO Management Circuit must be heparinized, so bleeding Circuit must be heparinized, so bleeding

potential existspotential exists CO2 may need to be added to blood after it CO2 may need to be added to blood after it

passes through membrane gas exchangerpasses through membrane gas exchanger 80% of cardiac output may initially be 80% of cardiac output may initially be

bypassedbypassed Patient is weaned to 10% bypass Patient is weaned to 10% bypass

(20 ml/kg/min)(20 ml/kg/min) SvO2 is maintained at 75%SvO2 is maintained at 75% Infant is kept on low PIP, PEEP, Rate, and Infant is kept on low PIP, PEEP, Rate, and

FIO2 while on ECMOFIO2 while on ECMO