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