ECLS The Basics Jeannine Hermens Intensive Care Center UMC Utrecht
Conflict of interest None
Terminology ECMO - ExtraCorporeal Membrane Oxygenation ECLS - ExtraCorporeal Life Support PLS - Veno-venous ECMO - Extracorporeal CO 2 removal (ECCO 2 R) - Pump Assisted Lung Protection (PALP) - Veno-arterial ECMO - Extracorporeal CPR (E-CPR) - Permanent Life Support Maquet
Extracorporeal Membrane Oxygenation Circuit Two BUY goals: TIME - Oxygenate - Extract carbon dioxide Daniel Brodie & Matthew Bacchetta. N Engl J Med 2011
First cardiopulmonary bypass Gibbon, 1953
History of ECMO First human ECMO - more than 40 years ago Hill JD et al. New Engl J Med 1972
First neonatal ECMO survivor
Neonatal ECMO
Transport on ECMO
ECMO in H1N1
ECMO at the Louvre
Arlt M. et al. Resuscitation. 2011 Arlt M. et al. Resuscitation. 2011
Hill JD et al. New Engl J Med 1972 History of ECMO First ECMO - more than 40 years ago
History of ECMO Evidence of beneficiance ECMO in respiratory failure 1979: VA ECMO vs conventional treatment in acute respiratory failure: both 90% mortality 1978: Kolobow and Gattinoni: ECCO2-R 2007; ELSO: 105 ECMO runs: 52% survival 2009: CESAR trial: (180 pts randomized): treatment in ECMO center beneficial (VV ECMO)
ECMO in cardiac failure History of ECMO Evidence of beneficiance Cove ME & MacLaren G. Critical Care. 2010
Extracorporeal Membrane Oxygenation Circuit Two goals: - Oxygenate - Extract carbon dioxide Daniel Brodie & Matthew Bacchetta. N Engl J Med 2011
Extracorporeal Membrane Oxygenation Oxygenator yanahammond.com
Hollow fiber Membrane oxygenator Polymethylpentene Heparin-coated High performance blood oxygenation CO 2 elimination low pressure drop Long duration 2-3 weeks Courtesy of Prof. Alain Combes, La Pitié-Salpetrière, Paris
Extracorporeal Membrane Oxygenation Oxygenator venous arterial
Extracorporeal Membrane Oxygenation Centrifugal blood pump magnetic levitation venous CentriMag designworldonline.com
Extracorporeal Membrane Oxygenation Centrifugal blood pump Electrical non-pneumatic non-pulsatile Centrifugal pump 0 4000 RPM venous Flows up 8 L/min Very reliable weeks
Extracorporeal Membrane Oxygenation Circuit Sidebotham D et al. Journal of Cardiothoracic and Vascular Anesthesia 2012
Extracorporeal Membrane Oxygenation Veno-arterial ECMO: both respiratory and cardiac support - peripheral cannulation - central cannulation Veno-venous ECMO: only respiratory support: pneumonia complicated by ARDS
Veno-Arterial ECMO Peripheral Cannulation Arroyo D, Cook S - Minim Invasive Surg (2011)
Veno-arterial ECMO Possible circuits: femoral-femoral femoral-axillary central cannulation BP - blood pump ML - membrane lung Scaravilli V et al. In: Sangalli F et al. (eds.), ECMO-Extracorporeal Life Support in Adults, Springer-Verlag Italia 2014
Pages ON et al. J Thorac Cardiovasc Surg. 2009
Loss of LV ejection and flow Increasing ECMO blood flow Scaravilli V et al. In: Sangalli F et al. (eds.), ECMO-Extracorporeal Life Support in Adults, Springer-Verlag Italia 2014
Harlequin syndrome Complicating peripheral VA-ECMO
Harlequin syndrome Complicating peripheral VA-ECMO Mondino MG et al. In: Sangalli F et al. (eds.), ECMO-Extracorporeal Life Support in Adults, Springer-Verlag Italia 2014
Harlequin syndrome Complicating peripheral VA-ECMO Mondino MG et al. In: Sangalli F et al. (eds.), ECMO-Extracorporeal Life Support in Adults, Springer-Verlag Italia 2014
Veno-Arterial ECMO Central Cannulation Marasco SF et al. Heart, Lung and Circulation 2008
Veno-venous ECMO Daniel Brodie & Matthew Bacchetta. N Engl J Med 2011 Example: CO 5 L/min ECMO flow: 3.5 L/min x sat 100% + 1.5 L/min x sat 70% = sat 91%
Veno-venous ECMO Percutaneous cannulation
Veno-Venous ECMO cannulation principles
Mobilizing on ECMO Source: Criticalcarecanada.com
Veno-venous ECMO Beneficial properties ARDS lung rest Percutaneous insertionbed side therapy Less bleeding complications
After ECMO insertion Monitoring Lung rest ventilation settings: low tidals, high PEEP Heparinization Monitoring arterial blood gas: right arm!
...Indications ECMO By Prof van Dijk