COMPLETE & ADVANCE
ADVANCED ICU
CONCEPTS NOTES
2025
, ADVANCED ICU CONCEPTS
EXTRACORPOREAL MEMBRANE
OXYGENATION (ECMO)
Extracorporeal Membrane Oxygenation (ECMO) is an advanced life-support
system that provides cardiac and/or respiratory support for critically ill
patients whose heart and lungs are unable to function adequately. It acts as an
artificial heart-lung system to oxygenate blood and remove carbon dioxide,
allowing the body to rest and heal.
OVERVIEW OF ECMO
Purpose
Supports gas exchange and/or circulatory function when conventional
therapies fail.
Used as a temporary bridge to recovery, transplant, or decision-making in
end-stage diseases.
Principle
Blood is drawn from the patient, oxygenated and cleared of carbon dioxide
in an external membrane oxygenator, and returned to the body.
TYPES OF ECMO
a. Veno-Arterial (VA-ECMO)
Function: Supports both cardiac and respiratory systems.
Mechanism:
Blood is removed from a central vein (e.g., femoral vein) and returned to a
central artery (e.g., femoral or aortic artery).
Indications:
Cardiogenic shock.
Cardiac arrest (as part of ECPR—extracorporeal cardiopulmonary
resuscitation).
Post-cardiotomy support.
Hemodynamics: Provides systemic perfusion and oxygen delivery.
, ADVANCED ICU CONCEPTS
TYPES OF ECMO
b. Veno-Venous (VV-ECMO)
Function: Supports only the respiratory system.
Mechanism:
Blood is removed from a central vein and returned to another central vein.
Indications:
Severe Acute Respiratory Distress Syndrome (ARDS).
Refractory hypoxemia or hypercapnia.
Hemodynamics: Does not provide circulatory support.
, ADVANCED ICU CONCEPTS
INDICATIONS FOR ECMO
Respiratory Indications
Severe ARDS unresponsive to conventional ventilation
strategies.
Severe pneumonia (e.g., COVID-19-associated ARDS).
Airway obstruction or trauma.
Cardiac Indications
Cardiogenic shock with low cardiac output despite
inotropes/vasopressors.
Cardiac arrest unresponsive to advanced life support.
Myocarditis or cardiomyopathy.
Other Indications
Massive pulmonary embolism with hemodynamic instability.
Bridge to lung or heart transplantation.
Post-operative support for heart or lung surgeries.
CONTRAINDICATIONS FOR ECMO
Contraindications for ECMO
Absolute Contraindications
Irreversible organ failure (e.g., advanced multi-organ failure).
Severe and irreversible neurological damage (e.g., brain death).
Relative Contraindications
Advanced age with poor prognosis.
Prolonged CPR with no return of spontaneous circulation (ROSC).
Severe coagulopathy or bleeding disorders.
ADVANCED ICU
CONCEPTS NOTES
2025
, ADVANCED ICU CONCEPTS
EXTRACORPOREAL MEMBRANE
OXYGENATION (ECMO)
Extracorporeal Membrane Oxygenation (ECMO) is an advanced life-support
system that provides cardiac and/or respiratory support for critically ill
patients whose heart and lungs are unable to function adequately. It acts as an
artificial heart-lung system to oxygenate blood and remove carbon dioxide,
allowing the body to rest and heal.
OVERVIEW OF ECMO
Purpose
Supports gas exchange and/or circulatory function when conventional
therapies fail.
Used as a temporary bridge to recovery, transplant, or decision-making in
end-stage diseases.
Principle
Blood is drawn from the patient, oxygenated and cleared of carbon dioxide
in an external membrane oxygenator, and returned to the body.
TYPES OF ECMO
a. Veno-Arterial (VA-ECMO)
Function: Supports both cardiac and respiratory systems.
Mechanism:
Blood is removed from a central vein (e.g., femoral vein) and returned to a
central artery (e.g., femoral or aortic artery).
Indications:
Cardiogenic shock.
Cardiac arrest (as part of ECPR—extracorporeal cardiopulmonary
resuscitation).
Post-cardiotomy support.
Hemodynamics: Provides systemic perfusion and oxygen delivery.
, ADVANCED ICU CONCEPTS
TYPES OF ECMO
b. Veno-Venous (VV-ECMO)
Function: Supports only the respiratory system.
Mechanism:
Blood is removed from a central vein and returned to another central vein.
Indications:
Severe Acute Respiratory Distress Syndrome (ARDS).
Refractory hypoxemia or hypercapnia.
Hemodynamics: Does not provide circulatory support.
, ADVANCED ICU CONCEPTS
INDICATIONS FOR ECMO
Respiratory Indications
Severe ARDS unresponsive to conventional ventilation
strategies.
Severe pneumonia (e.g., COVID-19-associated ARDS).
Airway obstruction or trauma.
Cardiac Indications
Cardiogenic shock with low cardiac output despite
inotropes/vasopressors.
Cardiac arrest unresponsive to advanced life support.
Myocarditis or cardiomyopathy.
Other Indications
Massive pulmonary embolism with hemodynamic instability.
Bridge to lung or heart transplantation.
Post-operative support for heart or lung surgeries.
CONTRAINDICATIONS FOR ECMO
Contraindications for ECMO
Absolute Contraindications
Irreversible organ failure (e.g., advanced multi-organ failure).
Severe and irreversible neurological damage (e.g., brain death).
Relative Contraindications
Advanced age with poor prognosis.
Prolonged CPR with no return of spontaneous circulation (ROSC).
Severe coagulopathy or bleeding disorders.
