Extracorporeal membrane Oxygenation (ECMO) temporarily supports patients with acute respiratory, cardiopulmonary, renal, cardiac failure. This modern approach started in the mid-20th century, with the first instance occurring in the 1970s.
Initially, it was used only for respiratory failure, but in the present time, it has emerged as a treatment for both cardiac and respiratory failure, making it an essential treatment modality for those patients who are experiencing failure of both heart and lungs. ECMO is used in conditions during which CVV, or other types of cardiac support or even conventional mechanical ventilation would not be sufficient.
ECMO is beneficial in several settings, such as acute respiratory distress syndrome and post-cardiotomy shock, as a bridge to lung or heart transplantation, and as a supportive measure in critical conditions for other treatment modalities that have been unsalvageable.
Indications
Acute Respiratory Distress Syndrome (ARDS): ECMO is mostly used as a supportive therapy when conventional mechanical support or non-invasive strategies fail to provide adequate support to patients with severe ARDS. It helps in improved evaluation of gas exchange, better oxygenation, and reduce frequency of any types of ventilator induced lung injury.
Cardiogenic Shock: It is also useful in cases of cardiogenic shock as mechanical support. This includes cases like heart failure that affects pumping of blood through the heart, situations pertaining to decreased cardiac output like post cardiopulmonary heart surgery, myocardial infarction, or any severe heart failure.
Hypothermic Cardiac Arrest: In case of cardiac arrest, ECMO may be integrated with therapeutic hypothermia for the patient. This type of combination should be capable to help and support the heart and the lungs while one waits for the body to rebuild.
Trauma or Severe Respiratory Failure in Adults: It has been used in emergency situations such as severe trauma, acute respiratory failure or with refractory hypoxemia in adults. It ensures effective oxygenation, and lung recruitment and prevents ventilator-associated lung injury.
Extracorporeal Cardiopulmonary Resuscitation (ECPR): ECMO is also used in ECPR scenarios Even in cases of refractory cardiac arrest, the patient might benefit from ECMO as part of the procedure.
Contraindications
Irreversible Organ Failure: The initiation of ECMO should not be done when there is evidence of failure of any organ that cannot be reversed. However, if the heart and lungs are visibly affected and have no possibility of functioning properly regardless of the medical intervention, the use of ECMO might be negative.
Advanced Age and Comorbidities: Cardiovascular disease, chronic renal failure, diabetes mellitus, malignancy, and severe liver and lung diseases may have an effect on survival and functional prognosis.
Prolonged Cardiopulmonary Resuscitation (CPR): If the underlying cause of a prolonged cardiac arrest is not reversible, cardiopulmonary resuscitation (CPR) is continued without initiating ECMO.
End-Stage Organ Dysfunction: Patients, specifically those with severe renal, hepatic, or other organ compromise, this group of patients might not qualify for ECMO because the ongoing multisystem dysfunction related to organ failure poses difficulties for the circulatory support system.
Outcomes
Equipment
ECMO Circuit
Cannulation
Anticoagulation Management
Safety Devices
ECMO Pumps
Oxygenators
Temperature Management
Monitoring Equipment
Arterial Blood Gas (ABG) Monitoring
Alarms and Alerts
In-Line Blood Gas Monitoring
Portable ECMO Systems
ECMO Coordinator
Extracorporeal Membrane Oxygenation system
Venoarterial (VA) Bypass and Venovenous (VV) Bypass
Venoarterial (VA) Bypass:Â
Step:1-Cannulation: In VA ECMO, two cannulas are usually utilized for the venous drainage function and arterial return function. It is placed into one large central vein, most preferably the right internal jugular or the femoral vein to pull off the deoxygenated blood from the patient. The return cannula, which is also known as the return line, is inserted back into a large artery, preferably femoral artery, to provoke the delivery of the oxygenated blood into the systemic circulation.
Step:2-Connection to the ECMO Circuit: The drainage cannula is connected between the venous part of the ECMO system so that it can take blood into the system. Another component present within the circuit is the oxygenator that helps to eliminate CO2 and introduce oxygen to the patient.
Step:3-Oxygenation: The patient’s blood is separated from the blood in the circuit through ECMO pumping with a continuous circulation of blood. During perfusion, the blood gets oxygenated and decarboxylated as it flows through the oxygenator. The pump then expels the oxygenated blood into the arterial system back to the various tissues in the body. Step:4-Monitoring: The crucial points of monitoring while performing VA ECMO, include flow rates, arterial and venous pressures and blood gas analyses. In addition, HR monitoring like the echocardiogram facilitates evaluation of the cardiac performance and any need for changes.
Step:5-Anticoagulation: These are medicines given to avoid thrombosis on the surface of the ECMO circuit. Heparin is usually prescribed for antagonizing the coagulation since it is effective, and the dosage is normally adjusted to prevent both clotting and hemorrhage.
Step:6-Weaning and Decannulation: Weaning is the process of gradually tapering off the VA ECMO as the patient’s cardiopulmonary function strengthens. Decannulation refers to the removal of the cannula used to access the patients’ vessels. Breathing stabilizes after three weeks and decannulation is conducted, where the cannulas are removed.
Venovenous (VV) Bypass:Â
Step:1 Cannulation: The procedure of VV ECMO involves inserting two cannulas for drainage of venous blood and reinjection of the blood the same in the circuit. The drainage cannula often enters a large central vein, for example into the right internal jugular or femoral vein, to remove low calorie blood. The return cannula is inserted into another large vein conveniently located in the internal jugular or subclavian position to pump oxygen-rich blood.
Step:2-Connection to the ECMO Circuit: The drainage cannula is connected to the venous side of the ECMO circuit, just like VA ECMO. This part of the extracorporeal circuit allows for the exchange of gases such as eliminating CO2 and introducing O2 into bloodstream.
Step:3-Pumping and oxygenation: This involves pumping of blood through the ECMO circuit and oxygenation provide to the amount of blood that is required in the body. When the blood gets to the oxygenator, it is mixed with a soluble substrate where the gaseous exchange occurs. The pump then returns the enriched blood to the venous cycle thus doing away with the need to use the patient’s lungs.
Step:4-Monitoring: VV ECMO should not be left unmonitored; rather, it should be monitored continuously. Significant areas for input consist of flow rates, pressures, and blood gas analysis results. Echocardiography examination can also help to determine the function of the heart and to make sure bypassed blood enters the veins properly.
Step:5- Anticoagulation: As with VA ECMO, anticoagulation is used to form a barrier to blood clotting within the ECMO circuit during the process of VV ECMO.
Step:6-Weaning and decannulation: Weaning from VV ECMO involves depriving the patient slowly of the amount of pump flow while observing the patient’s response and ability to support them through lung function. Decannulation then become stable and is undertaken by withdrawal of the cannulas.
Management of Extracorporeal Membrane Oxygenation
Pulmonary System Management in Extracorporeal Membrane Oxygenation (ECMO):Â
The pulmonary system management in ECMO for the following aspect of the patient care focuses on the crucial aspects like oxygenation and elimination of carbon dioxide. The ECMO circuit is a supportive device in that it functions like a lung; it provides the oxygen and the CO2 removal while the patient’s own lungs undergo repair. The ventilator settings are then modified to prevent ventilator-associated lung injury, and the ECMO pump work to bypass the lung, circulating fresh blood via the oxygenator. In this process, pulmonary parameters such as oxygen saturation and arterial blood gases that are continuously be measured helps in the alterations of techniques to do with ECMO and ventilators. Regular assessments are made regarding lung improvement, and advanced ventilation techniques are used to prevent conditions such as high pressure and volume causing harm to the lungs.
Cardiovascular System Management in Extracorporeal Membrane Oxygenation (ECMO):Â
ECMO management and care primarily focus on addressing the cardiovascular compromised and needing augmentation and adequate perfusion in the body. In Venoarterial (VA) ECMO, the ECMO circuit offers the patient the addition of a means to supply Oxygenated blood to the arterial system. ECMO, arterial and venous pressures must continually be checked to direct modifications of the pump flow rates. During conditions of severe cardiogenic shock, the ECMO pump effectively supports the function of the heart and creates the circulation. Anticoagulation is managed carefully. Adverse cardiac effects of radiation are monitored through evaluating the cardiac function of the patient through echocardiography as well as other regular assessments to determine the survival capacity of the heart. The procedure of gradually transitioning off ECMO allows the heart’s natural function to take over.
Complications:
Circuit Disruption: Issues such as kink, clot and or leakage may occur in an ECMO circuit. These issues can interfere with the convection, blood flow, and other operations of the circuits.
Thrombosis and Embolism: Nevertheless, thrombus or clot formation inside the circuit or embolism is still possible. Thrombi may cause problems with circulation near the circuit, and emboli may result in issues with the whole system.
Infection: Important complications of ECMO include infections, both localized and systemic, caused by the presence of the ECMO circuit. Strict conditions of aseptic methods, and constant supervision is vital to prevent infections.
Acid-Base and Electrolyte Imbalances: ECMO can directly cause changes in respective acid-base balance and concentration of the electrolytes. This implies that constant evaluation of the patient for his or her states of fluid and electrolyte balance is required regularly and sometimes frequently to achieve the physiological balance.
Organ Dysfunction: Longer ECMO support can create disturbances such as liver dysfunction, renal failure and neurological disorders, and higher costs. These concerns are not overlooked as regular check-ups and early interventions are carried out to avoid such causes.
Hemorrhagic Stroke: There is an increased risk of hemorrhagic stroke in patients under anticoagulation therapy. It is necessary to monitor the neurological status continuously and to adjust anticoagulation if needed, as well as to identify any neurological symptoms as early as possible.
Cannula-Related Infections: Complications may result at locations where cannulas are sited, particularly at areas of the body where they are located and inserted. Measures such as correct site care and surveillance of patients may possess the chances of developing cannula associated infections.
»
Home » Procedure » Extracorporeal Membrane Oxygenation
Extracorporeal Membrane Oxygenation
Updated :
September 3, 2024
Extracorporeal membrane Oxygenation (ECMO) temporarily supports patients with acute respiratory, cardiopulmonary, renal, cardiac failure. This modern approach started in the mid-20th century, with the first instance occurring in the 1970s.
Initially, it was used only for respiratory failure, but in the present time, it has emerged as a treatment for both cardiac and respiratory failure, making it an essential treatment modality for those patients who are experiencing failure of both heart and lungs. ECMO is used in conditions during which CVV, or other types of cardiac support or even conventional mechanical ventilation would not be sufficient.
ECMO is beneficial in several settings, such as acute respiratory distress syndrome and post-cardiotomy shock, as a bridge to lung or heart transplantation, and as a supportive measure in critical conditions for other treatment modalities that have been unsalvageable.
Acute Respiratory Distress Syndrome (ARDS): ECMO is mostly used as a supportive therapy when conventional mechanical support or non-invasive strategies fail to provide adequate support to patients with severe ARDS. It helps in improved evaluation of gas exchange, better oxygenation, and reduce frequency of any types of ventilator induced lung injury.
Cardiogenic Shock: It is also useful in cases of cardiogenic shock as mechanical support. This includes cases like heart failure that affects pumping of blood through the heart, situations pertaining to decreased cardiac output like post cardiopulmonary heart surgery, myocardial infarction, or any severe heart failure.
Hypothermic Cardiac Arrest: In case of cardiac arrest, ECMO may be integrated with therapeutic hypothermia for the patient. This type of combination should be capable to help and support the heart and the lungs while one waits for the body to rebuild.
Trauma or Severe Respiratory Failure in Adults: It has been used in emergency situations such as severe trauma, acute respiratory failure or with refractory hypoxemia in adults. It ensures effective oxygenation, and lung recruitment and prevents ventilator-associated lung injury.
Extracorporeal Cardiopulmonary Resuscitation (ECPR): ECMO is also used in ECPR scenarios Even in cases of refractory cardiac arrest, the patient might benefit from ECMO as part of the procedure.
Irreversible Organ Failure: The initiation of ECMO should not be done when there is evidence of failure of any organ that cannot be reversed. However, if the heart and lungs are visibly affected and have no possibility of functioning properly regardless of the medical intervention, the use of ECMO might be negative.
Advanced Age and Comorbidities: Cardiovascular disease, chronic renal failure, diabetes mellitus, malignancy, and severe liver and lung diseases may have an effect on survival and functional prognosis.
Prolonged Cardiopulmonary Resuscitation (CPR): If the underlying cause of a prolonged cardiac arrest is not reversible, cardiopulmonary resuscitation (CPR) is continued without initiating ECMO.
End-Stage Organ Dysfunction: Patients, specifically those with severe renal, hepatic, or other organ compromise, this group of patients might not qualify for ECMO because the ongoing multisystem dysfunction related to organ failure poses difficulties for the circulatory support system.
ECMO Circuit
Cannulation
Anticoagulation Management
Safety Devices
ECMO Pumps
Oxygenators
Temperature Management
Monitoring Equipment
Arterial Blood Gas (ABG) Monitoring
Alarms and Alerts
In-Line Blood Gas Monitoring
Portable ECMO Systems
ECMO Coordinator
Extracorporeal Membrane Oxygenation system
Venoarterial (VA) Bypass:Â
Step:1-Cannulation: In VA ECMO, two cannulas are usually utilized for the venous drainage function and arterial return function. It is placed into one large central vein, most preferably the right internal jugular or the femoral vein to pull off the deoxygenated blood from the patient. The return cannula, which is also known as the return line, is inserted back into a large artery, preferably femoral artery, to provoke the delivery of the oxygenated blood into the systemic circulation.
Step:2-Connection to the ECMO Circuit: The drainage cannula is connected between the venous part of the ECMO system so that it can take blood into the system. Another component present within the circuit is the oxygenator that helps to eliminate CO2 and introduce oxygen to the patient.
Step:3-Oxygenation: The patient’s blood is separated from the blood in the circuit through ECMO pumping with a continuous circulation of blood. During perfusion, the blood gets oxygenated and decarboxylated as it flows through the oxygenator. The pump then expels the oxygenated blood into the arterial system back to the various tissues in the body. Step:4-Monitoring: The crucial points of monitoring while performing VA ECMO, include flow rates, arterial and venous pressures and blood gas analyses. In addition, HR monitoring like the echocardiogram facilitates evaluation of the cardiac performance and any need for changes.
Step:5-Anticoagulation: These are medicines given to avoid thrombosis on the surface of the ECMO circuit. Heparin is usually prescribed for antagonizing the coagulation since it is effective, and the dosage is normally adjusted to prevent both clotting and hemorrhage.
Step:6-Weaning and Decannulation: Weaning is the process of gradually tapering off the VA ECMO as the patient’s cardiopulmonary function strengthens. Decannulation refers to the removal of the cannula used to access the patients’ vessels. Breathing stabilizes after three weeks and decannulation is conducted, where the cannulas are removed.
Venovenous (VV) Bypass:Â
Step:1 Cannulation: The procedure of VV ECMO involves inserting two cannulas for drainage of venous blood and reinjection of the blood the same in the circuit. The drainage cannula often enters a large central vein, for example into the right internal jugular or femoral vein, to remove low calorie blood. The return cannula is inserted into another large vein conveniently located in the internal jugular or subclavian position to pump oxygen-rich blood.
Step:2-Connection to the ECMO Circuit: The drainage cannula is connected to the venous side of the ECMO circuit, just like VA ECMO. This part of the extracorporeal circuit allows for the exchange of gases such as eliminating CO2 and introducing O2 into bloodstream.
Step:3-Pumping and oxygenation: This involves pumping of blood through the ECMO circuit and oxygenation provide to the amount of blood that is required in the body. When the blood gets to the oxygenator, it is mixed with a soluble substrate where the gaseous exchange occurs. The pump then returns the enriched blood to the venous cycle thus doing away with the need to use the patient’s lungs.
Step:4-Monitoring: VV ECMO should not be left unmonitored; rather, it should be monitored continuously. Significant areas for input consist of flow rates, pressures, and blood gas analysis results. Echocardiography examination can also help to determine the function of the heart and to make sure bypassed blood enters the veins properly.
Step:5- Anticoagulation: As with VA ECMO, anticoagulation is used to form a barrier to blood clotting within the ECMO circuit during the process of VV ECMO.
Step:6-Weaning and decannulation: Weaning from VV ECMO involves depriving the patient slowly of the amount of pump flow while observing the patient’s response and ability to support them through lung function. Decannulation then become stable and is undertaken by withdrawal of the cannulas.
Pulmonary System Management in Extracorporeal Membrane Oxygenation (ECMO):Â
The pulmonary system management in ECMO for the following aspect of the patient care focuses on the crucial aspects like oxygenation and elimination of carbon dioxide. The ECMO circuit is a supportive device in that it functions like a lung; it provides the oxygen and the CO2 removal while the patient’s own lungs undergo repair. The ventilator settings are then modified to prevent ventilator-associated lung injury, and the ECMO pump work to bypass the lung, circulating fresh blood via the oxygenator. In this process, pulmonary parameters such as oxygen saturation and arterial blood gases that are continuously be measured helps in the alterations of techniques to do with ECMO and ventilators. Regular assessments are made regarding lung improvement, and advanced ventilation techniques are used to prevent conditions such as high pressure and volume causing harm to the lungs.
Cardiovascular System Management in Extracorporeal Membrane Oxygenation (ECMO):Â
ECMO management and care primarily focus on addressing the cardiovascular compromised and needing augmentation and adequate perfusion in the body. In Venoarterial (VA) ECMO, the ECMO circuit offers the patient the addition of a means to supply Oxygenated blood to the arterial system. ECMO, arterial and venous pressures must continually be checked to direct modifications of the pump flow rates. During conditions of severe cardiogenic shock, the ECMO pump effectively supports the function of the heart and creates the circulation. Anticoagulation is managed carefully. Adverse cardiac effects of radiation are monitored through evaluating the cardiac function of the patient through echocardiography as well as other regular assessments to determine the survival capacity of the heart. The procedure of gradually transitioning off ECMO allows the heart’s natural function to take over.
Complications:
Circuit Disruption: Issues such as kink, clot and or leakage may occur in an ECMO circuit. These issues can interfere with the convection, blood flow, and other operations of the circuits.
Thrombosis and Embolism: Nevertheless, thrombus or clot formation inside the circuit or embolism is still possible. Thrombi may cause problems with circulation near the circuit, and emboli may result in issues with the whole system.
Infection: Important complications of ECMO include infections, both localized and systemic, caused by the presence of the ECMO circuit. Strict conditions of aseptic methods, and constant supervision is vital to prevent infections.
Acid-Base and Electrolyte Imbalances: ECMO can directly cause changes in respective acid-base balance and concentration of the electrolytes. This implies that constant evaluation of the patient for his or her states of fluid and electrolyte balance is required regularly and sometimes frequently to achieve the physiological balance.
Organ Dysfunction: Longer ECMO support can create disturbances such as liver dysfunction, renal failure and neurological disorders, and higher costs. These concerns are not overlooked as regular check-ups and early interventions are carried out to avoid such causes.
Hemorrhagic Stroke: There is an increased risk of hemorrhagic stroke in patients under anticoagulation therapy. It is necessary to monitor the neurological status continuously and to adjust anticoagulation if needed, as well as to identify any neurological symptoms as early as possible.
Cannula-Related Infections: Complications may result at locations where cannulas are sited, particularly at areas of the body where they are located and inserted. Measures such as correct site care and surveillance of patients may possess the chances of developing cannula associated infections.
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