ecmo at the u of m two era’s 1974 & 1986 1974 - 12 patients. kolobow membrane lung – roller...

ECMO AT THE U of M

• Two era’s 1974 & 1986

• 1974 - 12 patients. Kolobow Membrane Lung – Roller Pump – Adult and Peds. Patients. No Survivors

• 1986 to present - ? Patients. Several different oxygenators, Centrifugal pump only!

• ?% overall survival

CIRCIUTS FOR ECMO

• ARTERIAL VENOUS

• VENOVENOUS

• PERIPHERAL

• CENTRAL (OPEN CHEST)

CANNULATION TECHNIQUE NEONATE PERIPHERAL

• Neck cannulation

• Positioning of patient

• Sedation

• Surgical Prep

• Ideal Cannulae Position

Ideal Arterial Cannula Placement A V ECMO

• Cannula in Ascending Aorta just above Aortic valve (adjacent coronary ostia)

• Supplies oxygenated blood to coronaries and the rest of the circulation.

• Cannula tip should avoid proximity with the Aortic valve leaflets and stay out of left ventricle.

SINGLE CANNULA VENOVENOUS

• Dual luman cannula• Smallest size 14 fr. - limits use to patients

above 4 kg.• 15 Fr. – 4kg to < 9kg two lenghts• Flow recirculation 15-30%• Requires higher flows• No lung rest - must ventilate • Requires good cardiac function

VENEO/VENOUS IN ADULTS Peripheral cannulation

• Drainage from Femoral vein • Return SVC via Jugular access(Or visa versa)• Access may be percutanious or direct cut

down • Percutanious is better (less bleeding)• Requires ventilation (no lung rest)• Requires good cardiac function

VENO/ARTERIAL ADULTS

• Peripheral -Femoral vein, Femoral Artery– Limited distribution of blood centrally – Must have reversal of flow in Aorta for

oxygenated blood to reach Heart and Brain– Must place distal perfusion cannula in

Femoral artery

• Central cannulation - Aorta, Rt. Atrium– Complete cardiopulmonary support