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ECMO Journal Club

ECMO (extracorporeal membrane oxygenation) is a technique that removes carbon dioxide and oxygenates blood to provide lung and heart support. It allows for lung rest and tissue oxygen delivery when the lungs are severely damaged, as in ARDS (acute respiratory distress syndrome). A 70-year-old man who suffered smoke inhalation and later developed severe pneumonia and ARDS was placed on ECMO as he awaited a lung transplant. ECMO has complications related to the machine, cardiovascular and respiratory systems, and blood clotting, but can provide survival rates of 50-70% for respiratory failure cases.

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122 views15 pages

ECMO Journal Club

ECMO (extracorporeal membrane oxygenation) is a technique that removes carbon dioxide and oxygenates blood to provide lung and heart support. It allows for lung rest and tissue oxygen delivery when the lungs are severely damaged, as in ARDS (acute respiratory distress syndrome). A 70-year-old man who suffered smoke inhalation and later developed severe pneumonia and ARDS was placed on ECMO as he awaited a lung transplant. ECMO has complications related to the machine, cardiovascular and respiratory systems, and blood clotting, but can provide survival rates of 50-70% for respiratory failure cases.

Uploaded by

joe kayongo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ECMO

Tomanya Kenneth Kakuru


Resident One
12th April 2019
Outline
• ARDS - recap

• Definition

• Mechanism

• Indications and contraindications

• Complications
Case scenario
Case scenario
• 70/M, NL, 3 time Formula 1 world champion, suffered severe crash
1976. Smoke inhalational injury.

• 2018: suffered pneumonia with hemorrhagic alveolitis. ARDS.

• Placed on ECMO as he awaited long transplant

• 2019 : Recovering well.


ARDS
The Berlin Definition (2013)
• acute, with onset over 1 week or less

• bilateral opacities consistent with pulmonary edema

• PF ratio <300mmHg with a minimum of 5 cmH20 PEEP

• must not be  fully explained by cardiac failure or fluid overload


ARDS

ARDS Severity   PaO2/FiO2*   Mortality** 

Mild 200 – 300 27%

Moderate 100 – 200 32%

Severe < 100 45%


ARDS
• Mechanical Ventilation: proning, Recruitment Manouevres

• inhaled iNO

• inhaled prostacycline

• ECMO
ECMO - Definitions

ECMO terminology is used for modalities providing pulmonary support


system involving oxygenation and carbon dioxide removal
ECMO – Mechanism
ECMO – Mechanism
ECMO- Indications
• Remove CO 2 and oxygenate the blood

• Improve tissue oxygen delivery

• Allow normal physiologic metabolic milieu at tissue level

• Provide lung rest and/or cardiac offloading


ECMO – Contraindications
Absolute Relative
• progressive non-recoverable • age > 75
cardiac disease • multi-trauma with multiple
• progressive and non-recoverable bleeding sites
respiratory disease • CPR > 60 minutes
• chronic severe pulmonary • multiple organ failure
hypertension
• CNS injury
• advanced Malignancy
• unwitnessed cardiac arrest
ECMO – complications
• Machine and equipment

• Cardiovascular

• Respiratory

• Hematologic
ECMO – worth it?
• 55% survival for adult respiratory failure.

• Other observational and uncontrolled clinical trials have reported


survival rates from 50 to 70%
References
• https://lifeinthefastlane.com/ccc/ecmo/
• Sandeep chauwun , Annals of cardiac anaesthesia,
2011,Extracorporeal membrane oxygenation, an anesthesiologist's
perspective: Physiology and principles.

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