Adult ECMO – Questions With Reviewed Solutions
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Terms in this set (101)
AKA extracorporeal life support (ECLS)
Prolonged cardiopulmonary support/bypass by extra-
thoracic vascular cannulation
Definition of ECMO
Provides: days to weeks of pulmonary and/or cardiac
(what does it provide and
support to allow healing to occur
what benefits does it
serve?)
Benefit: the ability to decrease ventilator settings and
allow the lungs to rest, thus preventing the barotrauma
associated with high ventilator settings and/or FiO2
levels
1. Acute respiratory distress syndrome (ARDS)
What are the 2 basic forms
of respiratory failure?
2. Severe adult respiratory failure (SARF)
Definition = reduction in lung compliance, low
PaO2/FiO2 ratio (<200 mmHg) and bilateral alveolar
infiltrates as seen on chest X-ray (pulmonary
manifestation of SIRS)
What is acute respiratory Primary ARDS etiologies: bacterial, viral, aspiration or
distress syndrome (ARDS)? pneumocyxtic pneumonias' Legionnaire's disease,
pulmonary contusion
Secondary ARDS etiologies: sepsis, multisystem trauma,
pancreatitis, DIC, intestinal infarction, vasculitis,
postpartum
Definition = includes all causes of respiratory failures
What is severe adult
(e.g. severe asthmatic episodes and pneumonia), as well
respiratory failure (SARF)?
as ARDS
, - ARDS
- Pneumonia (e.g. bacterial, viral, aspiration)
- Post-lung transplant graft dysfunction
- Post-pneumonectomy pulmonary edema
- Anticipation that the respiratory failure will be
Respiratory Indications for
reversible within ~ 5 days
ECMO
- Severe respiratory failure despite optimal treatment
- Severe and life-threatening hypoxemia unresponsive
to conventional mechanical ventilation
- Hypercarbic respiratory failure (e.g. reactive airway
disease)
- Duration of respiratory failure and mechanical
ventilation > 7 days
- PaO2/FiO2 ratio < 100 for 5 days
- Multiple organ dysfunction syndrome defined as > 2
major organ systems failure
- Underlying severe chronic lung disease
Respiratory - Terminal disease with short life expectancy
Contraindications for - Active hemorrhage or bleeding diathesis (propensity
ECMO to bleed) that would be uncontrollable on heparin
- Positive HIV status
- Uncontrolled metabolic acidosis
- Septic shock
- Acute or chronic irreversible myocardial dysfunction
- Immunosuppression
- Central nervous system injury or malfunction
Conditions that lead to pure left or right ventricular
dysfunction maybe supported by VADs, however, VADs
support assumes that native lung is adequate
- ECMO can be used for support of any condition
resulting in cardiac dysfunction with poor oxygenation
Describe cardiac failure
Acute cardiac failure etiologies: MI, sepsis, trauma, viral
(where ECMO comes in
myocarditis, RV failure associated with pulmonary
and etiologies)
emblism
Chronic cardiac failure etiologies: end stage heart
disease with an acute cardiac event or as a bridge to a
VAD
, - Post-cardiotomy support
- Acute myocardial failure/myocarditis
- Intractable cardiopulmonary arrest
- Bridge to cardiac transplantation or ventricular assist
device support
Cardiac Indications for - Cardiogenic shock unlikely to recover without a
ECMO period of mechanical support
- Etiology of underlying heart disease and current
decompensation unknown
- Known neurologic status
- Anticipation that the cardiac failure will be reversible
within ~ 7 days (if not, a VAD should be used)
- Correct diagnosis uncertain
- Central nervous system damage
Cardiac contraindications - Malignancies
for ECMO - Irreversible end-organ damage (e.g. lungs, kidneys,
liver)
- Post-operative patient with controlled hemorrhage
Flow rate
- 30 - 80% of cardiac output
Cardiac support: partial to almost total
Veno-Arterial (V-A) ECMO
specifics Pulmonary support: allows for low pulmonary flow,
reducing pulmonary hypertension
(flow rate, cardiac support,
pulmonary support, Drainage (venous)
drainage and infusion) - right atrium via right internal jugular vein, femoral vein
or direct
Infusion (arterial)
- ascending aorta, axillary artery, femoral artery
- Full cardiopulmonary support allowing maximum rest
for the pulmonary and cardiac systems
Advantages of V-A ECMO
- Maximization of perfusion pressure to end organs
Save
Terms in this set (101)
AKA extracorporeal life support (ECLS)
Prolonged cardiopulmonary support/bypass by extra-
thoracic vascular cannulation
Definition of ECMO
Provides: days to weeks of pulmonary and/or cardiac
(what does it provide and
support to allow healing to occur
what benefits does it
serve?)
Benefit: the ability to decrease ventilator settings and
allow the lungs to rest, thus preventing the barotrauma
associated with high ventilator settings and/or FiO2
levels
1. Acute respiratory distress syndrome (ARDS)
What are the 2 basic forms
of respiratory failure?
2. Severe adult respiratory failure (SARF)
Definition = reduction in lung compliance, low
PaO2/FiO2 ratio (<200 mmHg) and bilateral alveolar
infiltrates as seen on chest X-ray (pulmonary
manifestation of SIRS)
What is acute respiratory Primary ARDS etiologies: bacterial, viral, aspiration or
distress syndrome (ARDS)? pneumocyxtic pneumonias' Legionnaire's disease,
pulmonary contusion
Secondary ARDS etiologies: sepsis, multisystem trauma,
pancreatitis, DIC, intestinal infarction, vasculitis,
postpartum
Definition = includes all causes of respiratory failures
What is severe adult
(e.g. severe asthmatic episodes and pneumonia), as well
respiratory failure (SARF)?
as ARDS
, - ARDS
- Pneumonia (e.g. bacterial, viral, aspiration)
- Post-lung transplant graft dysfunction
- Post-pneumonectomy pulmonary edema
- Anticipation that the respiratory failure will be
Respiratory Indications for
reversible within ~ 5 days
ECMO
- Severe respiratory failure despite optimal treatment
- Severe and life-threatening hypoxemia unresponsive
to conventional mechanical ventilation
- Hypercarbic respiratory failure (e.g. reactive airway
disease)
- Duration of respiratory failure and mechanical
ventilation > 7 days
- PaO2/FiO2 ratio < 100 for 5 days
- Multiple organ dysfunction syndrome defined as > 2
major organ systems failure
- Underlying severe chronic lung disease
Respiratory - Terminal disease with short life expectancy
Contraindications for - Active hemorrhage or bleeding diathesis (propensity
ECMO to bleed) that would be uncontrollable on heparin
- Positive HIV status
- Uncontrolled metabolic acidosis
- Septic shock
- Acute or chronic irreversible myocardial dysfunction
- Immunosuppression
- Central nervous system injury or malfunction
Conditions that lead to pure left or right ventricular
dysfunction maybe supported by VADs, however, VADs
support assumes that native lung is adequate
- ECMO can be used for support of any condition
resulting in cardiac dysfunction with poor oxygenation
Describe cardiac failure
Acute cardiac failure etiologies: MI, sepsis, trauma, viral
(where ECMO comes in
myocarditis, RV failure associated with pulmonary
and etiologies)
emblism
Chronic cardiac failure etiologies: end stage heart
disease with an acute cardiac event or as a bridge to a
VAD
, - Post-cardiotomy support
- Acute myocardial failure/myocarditis
- Intractable cardiopulmonary arrest
- Bridge to cardiac transplantation or ventricular assist
device support
Cardiac Indications for - Cardiogenic shock unlikely to recover without a
ECMO period of mechanical support
- Etiology of underlying heart disease and current
decompensation unknown
- Known neurologic status
- Anticipation that the cardiac failure will be reversible
within ~ 7 days (if not, a VAD should be used)
- Correct diagnosis uncertain
- Central nervous system damage
Cardiac contraindications - Malignancies
for ECMO - Irreversible end-organ damage (e.g. lungs, kidneys,
liver)
- Post-operative patient with controlled hemorrhage
Flow rate
- 30 - 80% of cardiac output
Cardiac support: partial to almost total
Veno-Arterial (V-A) ECMO
specifics Pulmonary support: allows for low pulmonary flow,
reducing pulmonary hypertension
(flow rate, cardiac support,
pulmonary support, Drainage (venous)
drainage and infusion) - right atrium via right internal jugular vein, femoral vein
or direct
Infusion (arterial)
- ascending aorta, axillary artery, femoral artery
- Full cardiopulmonary support allowing maximum rest
for the pulmonary and cardiac systems
Advantages of V-A ECMO
- Maximization of perfusion pressure to end organs
