This document provides an overview of extracorporeal membrane oxygenation (ECMO), including its history, modes, components, indications, contraindications, and complications. ECMO is an effective technique for providing emergency circulatory and respiratory support. It works by draining venous blood, oxygenating it through an artificial lung, and returning it to the circulation. There are two main modes - venoarterial (VA) ECMO which supports both heart and lung function, and venovenous (VV) ECMO which only supports lung function. Proper anticoagulation, volume management, and treatment of potential complications like bleeding, infection and circuit failures are important for safe ECMO management.
This document discusses extracorporeal membrane oxygenation (ECMO), which provides prolonged cardiopulmonary support. There are two main types of ECMO: venovenous (VV) ECMO, which provides respiratory support, and venoarterial (VA) ECMO, which provides both respiratory and hemodynamic support. The document outlines patient selection criteria and outcomes, complications, techniques for initiation and maintenance of ECMO, and considerations for weaning from and discontinuing ECMO support.
The intra-aortic balloon pump (IABP) is a mechanical device that increases coronary blood flow and reduces cardiac workload by inflating and deflating in sync with the cardiac cycle. It has a flexible catheter inserted into the femoral artery connected to a console that controls helium delivery. The balloon inflates in diastole to boost diastolic pressure and deflates in systole to reduce afterload. This improves cardiac output and oxygen delivery while decreasing oxygen demand. IABP is used in heart failure, unstable angina, cardiogenic shock, and high-risk cardiac procedures as a bridge to recovery or surgery. Nursing care involves monitoring for complications like bleeding, infection and limb ischemia.
ECMO is a form of extracorporeal life support that involves removing blood from the body, oxygenating it using an artificial lung, then returning it to circulate in the body. It can be used for both cardiac and respiratory support for neonates and involves different configurations depending on whether support is needed for the heart, lungs, or both. Indications for ECMO include meconium aspiration syndrome, congenital diaphragmatic hernia, respiratory distress syndrome, and persistent pulmonary hypertension among others. Outcomes have improved over time with advances in technology and experience with the procedure.
This document discusses PiCCO (Pulse Contour Cardiac Output) monitoring. PiCCO enables assessment of a patient's hemodynamic status by measuring various volumetric and cardiac parameters. It requires a central venous pressure catheter and arterial line. PiCCO works by transpulmonary thermodilution, using cold saline injections to calculate volumes, and pulse contour analysis of the arterial waveform to provide continuous cardiac output monitoring. The document defines various parameters measured by PiCCO like preload, contractility, lung function, and afterload, and provides normal ranges. It also outlines indications, contraindications and the decision tree for hemodynamic monitoring using PiCCO.
This document discusses hemodynamic monitoring in pediatrics. It begins with definitions of hemodynamics and hemodynamic monitoring. Both invasive and noninvasive monitoring methods are described, including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheterization. Complications of invasive methods are outlined. Normal hemodynamic parameters for children are provided. The document emphasizes the importance of hemodynamic monitoring in critically ill children to guide treatment and optimize tissue perfusion and oxygen delivery.
- ECMO is a form of extracorporeal life support that removes blood from the body, oxygenates it using an artificial lung, then returns it to the body.
- It was first developed in the 1950s and has been increasingly used since the 1970s for conditions like respiratory failure and cardiac failure.
- There are two main types - venovenous ECMO which only supports the lungs, and venoarterial ECMO which also supports the heart.
- ECMO is used as a temporary bridge for patients with severe, potentially reversible conditions while waiting for recovery, a decision on next steps, or an organ transplant.
Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
This document discusses extracorporeal membrane oxygenation (ECMO) as a treatment for severe acute respiratory distress syndrome (ARDS). It provides details on:
1. How ECMO works by using an external circuit to oxygenate blood and remove carbon dioxide before returning it to the body.
2. The types of ECMO (veno-venous and veno-arterial) and their indications.
3. The process of ECMO, including patient care focused on end organ perfusion to prevent further injury and improve function.
4. Complications of ECMO like bleeding, infections, and mechanical issues.
5. Considerations for when to initiate ECMO based on oxygenation levels
Cardiac output monitoring provides important information about a patient's hemodynamic status. There are several invasive and non-invasive methods to measure cardiac output. Invasive methods include thermodilution, Fick method, lithium dilution. Thermodilution, using a pulmonary artery catheter, is considered the clinical gold standard but has fallen out of favor due to risks. Non-invasive options include esophageal Doppler, bioreactance, pulse contour analysis, and partial CO2 rebreathing. Choice of monitoring method depends on the patient's condition and goals of therapy.
Pacemakers are electronic devices that can be used to initiate a heartbeat when the heart's intrinsic electrical system cannot effectively generate an adequate heart rate. There are temporary pacemakers, which are used until the underlying condition resolves, and permanent pacemakers. A pacemaker system consists of a pulse generator and pacing leads. The pulse generator delivers electrical pulses through the leads to stimulate the heart. Pacemakers can pace one or both chambers of the heart and are programmed with settings for rate, output, and sensitivity. Nurses monitor for pacemaker function and complications and educate patients on pacemaker care.
Transcutaneous pacing is a temporary means of stimulating the heart electrically from the outside of the chest to treat bradycardia and heart block. It delivers pulses through pads placed on the chest to pace the heart until the underlying cause is resolved or a permanent pacing strategy can be applied. The goals are to keep the patient stable hemodynamically. Settings adjusted include pacemaker rate and output level, and mode (asynchronous fixed rate or synchronous demand). The procedure involves applying pads and monitoring for electrical and mechanical capture as output is increased until the heart rate is stabilized.
ECMO provides cardiopulmonary support by oxygenating blood and supporting circulation outside the body. The history of ECMO began in the 1930s with experiments in extracorporeal circulation and progressed to successful use in humans in the 1950s. Indications for ECMO include cardiac and pulmonary failure. Contraindications include advanced organ failure or inability to anticoagulate. Cannulation techniques include central cannulation through major blood vessels or peripheral cannulation through the neck or groin.
Temporary cardiac pacing is used to treat acute bradyarrhythmias or tachyarrhythmias until the underlying condition resolves or permanent pacing can be initiated. It aims to re-establish normal hemodynamics compromised by abnormal heart rates. Transvenous pacing is the preferred method, involving insertion of endocardial leads through veins to the heart. Precise lead placement is important and is confirmed with imaging. Pacing parameters like threshold, rate and sensing are optimized. Complications include those related to vascular access and device malfunction requiring troubleshooting. Close monitoring is needed to ensure proper pacing and detect any issues.
This document discusses ventilator settings and modes. It begins by defining a ventilator and listing some key settings such as respiratory rate, tidal volume, minute ventilation, fraction of inspired oxygen, and positive end expiratory pressure. It then discusses the different types of ventilator modes: controlled modes (e.g. volume control, pressure control), supported modes (e.g. pressure support), and combination modes (e.g. SIMV with pressure support). The document concludes by outlining the steps for assessing a patient's readiness for weaning from the ventilator and describing methods for weaning such as a spontaneous breathing trial.
The document provides information about intra-aortic balloon pumps (IABP). It discusses that IABPs were first described in 1958 and have since improved. IABPs provide temporary left ventricular support by displacing blood in the aorta. They work by inflating in diastole and deflating before systole to increase cardiac output and coronary perfusion pressure while decreasing workload. IABPs are used for cardiac failure, unstable angina, postoperative complications, and as a bridge to transplantation. Complications include limb ischemia, bleeding, thrombosis, and infection.
This document discusses hemodynamic monitoring components used to evaluate the cardiovascular system. It describes how components such as heart rate, blood pressure, cardiac output, stroke volume, central venous pressure and pulmonary artery pressures are measured and used to establish baseline values, evaluate trends, determine dysfunction, and guide interventions. Factors that influence hemodynamics like preload, afterload, contractility and resistance are also explained. Normal ranges for various measurement values are provided.
This document discusses various aspects of venovenous extracorporeal membrane oxygenation (VV ECMO) cannulation and management. It provides details on different cannulation strategies and their effects on recirculation. Specifically, it notes that femoro-atrial cannulation had significantly less flow requirement compared to atrio-femoral cannulation during VV ECMO. It also discusses techniques to minimize recirculation like using larger dual-lumen cannulae and ultrasound guidance for proper cannula positioning. Monitoring recirculation is important to optimize ECMO efficiency and outcomes.
This document provides information on arterial line insertion and monitoring. It discusses indications for arterial lines, equipment needed, insertion techniques, complications, and troubleshooting. The radial artery is typically used as it has a low complication rate and is superficial, allowing for easy compression if needed. Continuous monitoring of arterial waveforms is important to ensure accurate blood pressure readings and detect any issues. Troubleshooting involves assessing the waveform, equipment, and catheter placement to address potential problems like dampening or resonance in the tracing.
This document discusses ECMO cannulation and potential pitfalls. It begins by outlining the personnel and equipment needed for ECMO, including pumps, oxygenators, and cannulas. It then describes the types of ECMO (VA and VV) and considerations for cannula choice and placement. Key steps in cannulation like imaging, vessel access and cannula fixation are covered. Management of the ECMO circuit and potential complications are also reviewed. Specifically, protocols for bleeding management, cannulation failures and malpositions are outlined to minimize risks. Overall, the document provides guidance on safely establishing ECMO support through cannulation and ongoing management.
Extracoporeal Life Support presentation finalAshraf Banoub
1) Extracorporeal life support (ECLS) is a mechanical means of temporarily supporting heart and lung function during cardiopulmonary failure, allowing for organ recovery or replacement.
2) ECLS can be used for both cardiac and respiratory failure indications when mortality risks are high despite optimal conventional therapy.
3) The ECLS circuit involves removing blood from the body, oxygenating it using a membrane lung, and returning it to the body through vascular access via the veins and arteries. Proper blood flow and gas exchange parameters must be monitored and maintained.
This document discusses various clinical procedures including oxygen therapy, central venous therapy, electrocardiography, and pulse oximetry. It provides details on the purpose, indications, delivery systems or principles, nurse responsibilities, documentation, and considerations for each procedure. Common procedures like administering oxygen via nasal cannula or mask, inserting central venous lines, performing electrocardiograms, and monitoring pulse oximetry are explained.
- ECMO is a form of extracorporeal life support that involves removing blood from the body, oxygenating it using an artificial lung, then returning it to circulate oxygenated blood through the body.
- It was first developed in the 1950s and saw its first successful use in 1971. It is now commonly used to support patients with severe cardiac and/or respiratory failure.
- There are two main types - venoarterial (VA) ECMO which supports cardiac function and venovenous (VV) ECMO which supports respiratory function. Indications, complications, and outcomes were discussed.
This document describes the case of a 29-year-old male who suffered an out-of-hospital cardiac arrest. He was brought to the emergency department still in pulseless electrical activity. The document discusses considering extracorporeal membrane oxygenation (ECMO) for the patient and summarizes the steps taken to initiate venoarterial ECMO. It provides an overview of ECMO and the evidence from the CHEER trial showing improved survival rates for cardiac arrest patients treated with ECMO, hypothermia, and early reperfusion. The patient in this case survived and was discharged with no neurological deficits.
Anaesthesia for cardiopulmonary bypass surgery [autosaved]Nida fatima
This document discusses cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and through an external circuit that oxygenates the blood and returns it to the body. CPB allows surgery to be performed on an unbeating heart while still providing circulation. The key components of a CPB machine and roles of the perfusionist in managing it are described. Steps in CPB like priming, hypothermia, myocardial preservation via cardioplegia, and monitoring techniques are summarized.
Shock is characterized by a systemic reduction in tissue perfusion resulting in decreased oxygen delivery. There are four main types of shock: hypovolemic, cardiogenic, obstructive, and distributive. The goals of resuscitation are to increase oxygen delivery and decrease demand. Treatment involves establishing IV access, fluid resuscitation, vasopressors, inotropes, antibiotics for infection, and treating the underlying cause. Endpoints of resuscitation include restoration of blood pressure, normalization of heart rate, urine output, lactate levels, and mental status.
Laryngectomy involves removing the larynx and parts of the trachea for laryngeal cancer. It requires a team approach and optimizing cardiac, respiratory, and nutritional status preoperatively. The procedure involves creating a permanent tracheostomy and repairing the pharynx. Postoperatively, careful monitoring of the airway, ventilation, nutrition, and rehabilitation is needed.
1. Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are important life support therapies used in intensive care units.
2. ECMO uses an external circuit to oxygenate blood and remove carbon dioxide, functioning as a bridge to recovery, transplant, or decision. CRRT slowly removes waste and fluid from the blood of patients with kidney failure or injury.
3. The document discusses the principles, indications, techniques, and complications of ECMO and CRRT, highlighting their roles in supporting critically ill patients with cardiac, respiratory, or renal issues.
This document provides an overview of invasive procedures including peripheral venous cannulation, central lines, arterial lines, and intraosseous infusion. It discusses indications, contraindications, equipment needed, and techniques for each procedure. Complications are also reviewed. Key points include choosing the appropriate cannula size based on intended use, selecting sites that provide optimal venous access, using sterile technique to minimize infection risk, and being prepared for emergencies by having the skills for intraosseous infusion when intravenous access cannot be quickly obtained.
POST OPERATIVE CARE MANAGEMENT OF SURGICAL PATIENTSOwoyemiOlutunde
This document outlines guidelines for post-operative care, including:
- Monitoring vital signs as patients recover from anesthesia and are transferred to recovery rooms or wards.
- Checking for specific complications like respiratory issues, cardiovascular problems, gastrointestinal issues, and more.
- Outlining management of issues like fever, pressure sores, and ensuring readiness for discharge. The document provides thorough guidance for nurses to safely monitor and care for patients in the critical post-operative period.
This document outlines guidelines for post-operative care, including:
- Monitoring vital signs as patients recover from anesthesia and are transferred to recovery rooms or wards.
- Checking for specific complications like respiratory issues, cardiovascular problems, gastrointestinal issues, and more.
- Outlining management of issues like fever, pressure sores, and ensuring readiness for discharge. The document provides thorough guidance for nurses to safely monitor and care for patients in the crucial post-operative period.
1) Thoracic anesthesia presents unique physiologic challenges including lung mechanics changes with lateral positioning, open pneumothorax risks, and one lung ventilation complications like hypoxic pulmonary vasoconstriction inhibition.
2) Careful patient evaluation and optimization is important preoperatively, including pulmonary function tests and cardiac evaluation. Intraoperatively, techniques like double lumen tubes, lung isolation, and thoracic epidural analgesia are utilized.
3) Postoperative complications can include pulmonary issues like edema, hemorrhage, or respiratory failure. Prolonged air leaks or bleeding may require chest tube insertion.
This document provides information on chest tube management including indications, contraindications, supplies needed for insertion, sizing, positioning, insertion technique, complications, nursing role, documentation, drainage system components, safety, exercise, pain management, dressing changes, and signs to monitor and report. The goal of chest tube placement is to drain fluid or air from the pleural space and re-expand the lung. Nursing plays a key role in monitoring the patient and drainage system.
1. Initial approach to undifferentiated hypotension in the ICU involves stabilizing the airway, securing IV access, performing risk stratification based on history and ECG, and considering common life-threatening conditions.
2. Common causes of hypotension that require emergent intervention include anaphylaxis, tension pneumothorax, cardiac tamponade, cardiogenic shock from MI or valvular insufficiency, acute arrhythmias, and hypovolemia.
3. POCUS can be used as part of the initial evaluation to identify potential causes of shock such as pericardial effusions, decreased ventricular function, IVC size and collapse, pneumothorax, AAA,
Cardiopulmonary bypass (CPB) temporarily takes over the function of the heart and lungs during surgery by circulating and oxygenating the blood. It allows correction of cardiac defects that were previously not surgically treatable. The basic CPB circuit involves draining blood from the veins into an oxygenator and reservoir before pumping it back into the arteries. Key components include cannulas, a pump, oxygenator, heat exchanger, and cardioplegia delivery system. CPB requires anticoagulation and precise monitoring to safely divert blood flow around the heart while surgical repairs are made before returning the patient to full cardiac function. Complications can include bleeding, infection, organ dysfunction, and neurological issues. Advances like centrifugal pumps
1. The document describes a case of a 28-year-old female with cyanotic congenital heart disease who underwent an arterial switch operation with integrated ECMO support.
2. ECMO is a form of extracorporeal life support used for both cardiac and respiratory failure in adults. It involves pumping blood out of the body to an artificial lung for gas exchange before returning it to circulation.
3. The key components of an ECMO circuit include a blood pump, membrane oxygenator, tubing, heat exchanger, and monitoring equipment. Proper anticoagulation and flow rates are important for safety and effectiveness.
Hergen Buscher is an Intensivist from St Vincent's hospital in Sydney. He has extensive experience with ECMO, in both veno-venous and veno-arterial contexts. Listen to this talk he gave on the most recent developments in ECMO and where things are heading.
This talk was given live in September 2014 for an Intensive Care Network (ICN) NSW meeting.
Go to www.intensivecarenetwork.com for more.
2025 QPP: Proposed Changes from the PFS Proposed RuleShelby Lewis
CMS has released the 2025 PFS Proposed Rule and proposed several changes to the Quality Payment Program. Here is a slideshow that highlights the key changes.
EFFECTIVE & SCIENTIFICALLY PROVEN WEIGHT LOSS PROGRAMMoses Alonge
Supper and Scientifically Proven Methods for Effective Weight Loss. It's safe and highly effective with notable results in just few days. You don't need all the "chemical pills" that endanger your health and leave your life at the risk of the attendant adverse effects.
Believe me: it has been tested and trusted over time with high success rate.
Check it out here:
https://3w105.doctortrf.com/l/?sub1
The success of our Spa in Ajman relies on the customer-centric approach we follow. Who doesn't like a massage center that consistently offers wellness treatments that help customers improve overall health? Our wellness services are carefully customized to satisfy the wellness needs of all customers. At Malayali Kerala Spa Ajman we providing Kerala Massage, Indian Massage, Full Body Massage, Russian Massage, Body to Body Massage in Ajman. Providing all our services @ just 99 AED.
SA Gastro Cure(gallbladder cancer treatment in india).pptxVinothKumar70905
SA Gastro Cure provides complete gallbladder cancer treatment in India, with Dr. Santhosh Anand's experience. Dr. Santhosh Anand delivers tailored care with modern procedures and advanced technologies to ensure efficient management and recovery. His significant knowledge provides premium therapy for gallbladder cancer, resulting in superior patient results at SA Gastro Cure.
Benefits:
The joined thumbs accentuate
all the manifestations of the fire
element within your body and mind,
and accelerate their effects, improving
eyesight and digestion, among other
things.
At the same time, the pressure applied to the backs of the fingers serves to decrease the effects of the air and space elements.
Maximize efficiency and accuracy in medical billing with our comprehensive solutions tailored to your practice's needs. Our expert team ensures timely reimbursements and minimized denials, so you can focus on providing quality patient care. visit: www.velanhcs..com
TEST BANK For Carolyn Jarvis, Physical Examination and Health Assessment 4th ...rightmanforbloodline
TEST BANK For Carolyn Jarvis, Physical Examination and Health Assessment 4th Canadian Edition 2024 Verified Chapters 1 - 31.pdf
TEST BANK For Carolyn Jarvis, Physical Examination and Health Assessment 4th Canadian Edition 2024 Verified Chapters 1 - 31.pdf
TEST BANK For Carolyn Jarvis, Physical Examination and Health Assessment 4th Canadian Edition 2024 Verified Chapters 1 - 31.pdf
Dawn of new Era: Digital Human, Agentic AI, and Auto sapiensJAI NAHAR, MD MBA
This interactive talk focuses on Intelligent Digital
agents, Digital human, and Embodied agents, which
are important emerging applications of Generative AI
in 2024 and beyond.
Benefits:
This Mudra is useful for people to sweat a lot, this mudra helps the body to retain water.
There are no other specific uses of this Mudra.
It is found that, if you have to pee but for some reason you can’t go, performing this Mudra will reduce the bladder pressure and you can hold it in for a bit longer.
The Future of Hair Loss Treatment: Harnessing Stem Cells with Dr. David GreeneDr. David Greene Arizona
Hair loss is no longer a condition that must be endured in silence. Thanks to the groundbreaking work of experts like Dr. David Greene, stem cell therapy is emerging as a powerful tool in the fight against hair loss. With continued research and development, this innovative approach holds the promise of transforming the lives of those affected by hair loss, offering a future where a full head of hair can be restored naturally and effectively.
Innovations in Hair Loss Treatment: The Role of R3 Stem CellR3 Stem Cell
R3 Stem Cell is revolutionizing hair loss treatment with cutting-edge regenerative medicine. By harnessing the power of stem cells, R3 Stem Cell offers a novel approach to hair restoration that rejuvenates and regenerates hair follicles. This minimally invasive treatment involves extracting a patient’s own stem cells, processing them, and injecting them into the scalp to stimulate natural hair growth and improve scalp health. Patients experience significant improvements in hair density and thickness, making R3 Stem Cell a leader in effective and natural hair loss solutions.
Asana and Bio-Mechanism Course
course, you will receive a certificate of completion of the Asana and Bio-mechanism Teacher Training Course, which you can count towards your continuing education. Our yoga teacher training courses are accredited by Yoga Alliance USA.
Asana and Bio-mechanism Teacher Training Course
The Yoga Biomechanics course aims to deepen students’ understanding of yoga by studying the biomechanics of yoga poses, learning how to apply anatomical guidelines to position correct positions, studying effective teaching techniques in a variety of situations, and exploring the history and philosophy of yoga.
What is Biomechanism?
Biomechanics is the use of mechanical methods to study the mechanical structure, function and movement of biological systems at any level from the entire organism to organs, cells and organelles.
3. What is ECMO??
• Ecmo is an effective technique to provide emergency
mechanical circulatory support for patients with
reversable cardiac / respiratory failure.
4. GOAL OF ECMO
• Ensure oxygen supply meets/exceeds patient demand
• Prevent end organ dysfunction and tissue damage
• Rest heart/lung
• Allow time for healing
5. PHYSIOLOGY:
• Draining venous blood ,
achieving gas exchange by
removing Co2 and adding
O2 through an artificial lung
and returning blood to the
circulation via VV or VA
mode
BLOOD
DRIANAGE
BLOOD
REINFUSION
BLOOD
TREATMENT
Add O2 and
Remove
CO2
11. VA ECMO(Veno-Arterial)
1. Heart and lung functions are
replaced totally/ partially.
2. Provide pulmonary and
hemodynamic support
3. Venous /drainage and arterial/return
12. Clinical Indications for VA-ECMO
1. Low cardiac index < 2L/min
2. hypotension despite inotropic support and an IABP
3. Cardiogenic Shock or Severe cardiac failure
• ACS
• Refractory arrhythmia’s
• Sepsis with profound myocardial dysfunction
• Drug overdose/toxicity with profound myocardial
dysfunction
• Myocarditis
• Pulmonary Embolism
• Cardiac Trauma
• Acute Anaphylaxis
13. Clinical Indications for VA-ECMO
• Post Cardiotomy: Inability to wean from CPB after CT
Surgery
• Post Heart Transplant: Primary graft dysfunction
• Chronic Cardiomyopathy:
• Bridge to durable LVAD support
• Bridge to transplant
• Periprocedural support for high-risk PCI
14. VV-ECMO (Veno-Venous)
Goal is to rest the lung
1. Blood is drained from jugular or femoral vein
and returned to the venous circulation.
2. Mix with venous blood returning from
systemic organs and increases O2 and lower
Co2 in the right atrial blood
3. Does NOT provide cardiac support
15. Clinical Indications for VV-ECMO
• Acute respiratory distress syndrome:
• Severe bacterial or viral pneumonia
• Aspiration syndromes
• Extracorporeal assistance to provide lung rest
• Airway obstruction
• Pulmonary contusion • Smoke inhalation
16. Clinical Indications for VV-ECMO
• Lung transplant
• Primary graft failure s/p transplant
• Bridge to transplant
• Lung hyperinflation
• Status asthmaticus
• Pulmonary hemorrhage or hemoptysis
• Congenital diaphragmatic hernia
17. Single site cannulation
One double lumen catheter inserted
through the right I J into the right atrium
Blood is drained and returned through
separate lumens in the same cannula
18. Absolute Contraindications
for ECMO
• Unrecoverable heart and not a candidate for Tx
• Disseminated malignancy
• Known severe brain injury
• Unwitnessed cardiac arrest
• Prolonged CPR without adequate tissue perfusion
• Unrepaired aortic dissection
19. Absolute Contraindications
for ECMO
• Severe aortic regurgitation
• End-Stage organ dysfunction: COPD, Cirrhosis, ESRD
• Compliance: (Financial, cognitive, psychiatric, or social limitations
without social support)
• Peripheral vascular disease in VA ECMO
• Advanced age and Obesity
21. Ecmo circuit (pump)
• The pump speed is in revolutions per minute (RPM)
• Typical pump speeds are about 2000-6000 RPM
Flow through the pump depends on 3 things:
1. Pump speed
2. The blood volume available
3. Downstream resistance
22. Blender
• The blender is a device which
provides fresh gas to the
oxygenator. The gas is a mixture of
nitrogen and oxygen.
23. Oxygenator
• most complicated component
of the ECMO circuit
• It is essentially a large thin
membrane made of a polymer
which allows gas to diffuse
across it.
• oxygenate the patient's blood
and remove carbon dioxide.
• The rate that gas is delivered
is referred to as the sweep
and can be set anywhere
between 0-15 L/min.
24. Ecmo circuit (CONTROLLER)
• The controller allows
the operator of the
ECMO circuit to
adjust the settings
as needed.
28. Preparation for Ecmo
• Multidisciplinary team approach
• Charge Nurse:
Call Ecmo coordinator who will activate the
team
Inform Surgeon/ Intensivist
Alert OR and perfussionist
Inform blood bank
Arrange Ecmo cart
29. Preparation for Ecmo
• Primary Nurse:
Should be present always at bedside
Co-ordinate with CN to arrange blood products
Ensure ABG and VBG available before insertion
Prepare: Inotropes/ Vasopressors'
IV heparin
Epinephrine/ Calcium, Soda bicarb
Albumin 5% and Normal saline
Sedation and paralytic agents
30. Preparation for Ecmo
• Primary Nurse:
Administer medications as needed
Give boluses of heparin
Run blood products
Titrates inotropes according to vitals
Blood gas and full set of laboratory investigations
ACT monitoring and anticoagulation Protocol
31. Anticoagulation:
• Prior to cannulation: Heparin 100units/kg( After introducing the
guide wire)
ACT range:
VA Ecmo: 180-220
VV Ecmo: 160-180
ACT should be measured hourly for first 12 hour and Q 4 hourly
unless clinically indicated
APTT every 4 hours then according to patient condition( Bleeding)
If low flow increase ACT
If Bleeding decrease ACT
Heparin protocol: 10-20 units/kg/hr
32. Titration:
Following cannulation
Blood flow increased until
respiratory and
hemodynamic parameters
are satisfactory
Target:
SaO2 in ABG > 90% in VA Ecmo
> 75% in VV Ecmo
SaO2 in VBG: 20- 25% lower than ABG
Adequate tissue perfusion evident
by:
Arterial blood pressure
Venous O2 saturation
Blood lactate level
33. Daily management
1. Monitor and record alarm limits
2. Ensure proper head to foot assessment
3. Check Ecmo circuit for clots, leak, connector and canula
position
4. Assess cannula site( Dressing and suture)
5. Ensure availability of 4 clamps at bedside
6. Ensure hand crank device available at bedside
34. Daily management
7. Make sure Ecmo plug is connected to red electrical circuit
8. Check function of heat exchanger, water level and color
9. CXR as ordered
10. ACT and coagulation profile
11. Maintain temperature 37c and avoid hypothermia
35. Ventilator management
• Low setting to allow lungs to rest
low respiratory rate with long inspiratory time
PIP under 25cmH2O
FiO2 (30-40%)
PEEP between 5-15cm H2O
Initial Deep sedation to inhibit respiratory efforts
36. Volume fluid balance
• Keep CVP 5-10 mmHg (rationale: Adequate volume for venous
drainage)
• Consider diuretics until dry weight
• If ARF – consider hemodialysis
38. • VV Ecmo: if patient became unstable use ACLS immediately
• VA Ecmo: If patient became Unstable try to trouble shoot as we have
cardiac support with Ecmo
• If there is no flow: decrease the speed and give volume
40. NURSING
• Maintain strict infection control
• Restrict accesses to essential personnel
• Remove unnecessary invasive lines
• Ensure crash cart trolley in close proximity
• Restriction in Mobility: Ensure appropriate mattress. Once a
day pressure care,
Preferably in day shift
• Log rolled
• Ecmo patient must not be left unattended at any time.
41. NURSING
• Mouth, Eye and catheter Care
• Use swabs, no tooth brushes
• No Shaving with razor
• Do not dislodge clots covering wound and insertion site
• Don’t do routine tracheal and mouth suction.
43. Bleeding
• occurs in 30- 40% of patients in ECMO
• Due to continuous heparin infusion and platelet dysfunction
TREATMENT
• Maintaining platelet count
• Decrease heparin infusion & maintain ACT at 160 Sec
• Surgical Exploration if major bleeding occurs
45. Heparin Induced
Thrombocytopenia
• HIT can occur in patients with ECMO
• When HIT is proven, Heparin infusion should be replaced by non-
heparin anticoagulant.
46. Recirculation
• Reinfused blood is withdrawn
through the drainage cannula
without passing through the
systemic circulation
INTERVENTION
• Increase the distance between
cannula
• Use the single site double lumen
cannula
• Addition of another drainage
cannula
47. CARDIAC ARREST
• VV ECMO
.call for help
.CPR
.Reversible causes
• VA ECMO
.Establish adequate flow
.Call for help
.Reversible Causes
.CPR may not be needed
unless pump compromised
48. ACCIDENTAL
DECANNULATION
• Call for Help
• Clamp Circuit
• Turn of pump
• CPR
• Establish ventilation & ionotropic support
• Volume ( Note: Total circuit volume 500cc)
• Peripheral : Apply pressure
• Central: Prepare chest opening
49. CIRCUIT RUPTURE
• Clamp the circuit
• Call for help
• Contact medical team
• Increase the ventilator support and inotropes
to compensate for loss of support
• Give volume to replace blood loss
• In the event of cardiopulmonary arrest , CPR
should be commenced
50. Circuit air embolism
• Clamp the circuit and switch off pump to
[prevent potential introduction of air into
the patient
• Call for help
• Provide ventilation and hemodynamic
support(including CPR as indicated)
51. Heat exchanger failure
• Turn off heater
• Contact team
• Use warming blanket to control patient temperature
52. Pump failure
• Call for help
• Contact team
• Provide ventilation and hemodynamic support
• ECMO specialist or perfusionist should be available to troubleshoot
ECMO console
53. Weaning
Be knowledgeable of the signs of weaning
• Improving oxygenation
• Reduced Co2 Retention
• Improving Chest X ray
• Blood flow unchanged in Ecmo
• Stable ABG > 6 hours without Oxygenator support
54. DECANNULATION
• Clotting and Platelet level before decanulation
• Discontinue heparin infusion 2-4 hours or as ordered
prior to decanulation
• Ensure that direct pressure is applied on the insertion
site for at least 20 min
• Lower limb Doppler.