ECMO ndash A BRIDGE TO RECOVERY

Dr SK Varma MS FRCS(Ed) MCh DNB FIACS

Chief Cardiothoracic Surgeon

KG Hospital Coimbatore 641018

wwwskvarmacom

What is ECMO

bull Extra corporeal

bull Membrane

bull Oxygenation

bull (Pump)

When Is ECMO Used

bull Support the failing heart and or lungs by temporarily taking over their functions allowing rest and repair and rejuvenation

bull Bridge to recovery

bull Bridge to transplant

Pumps

bull Centrifugal

bull Roller

Membranes

bull Silicone rubber

bull Microporuspolypropylene

bull Polymethyl pentene

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

What is ECMO

bull Extra corporeal

bull Membrane

bull Oxygenation

bull (Pump)

When Is ECMO Used

bull Support the failing heart and or lungs by temporarily taking over their functions allowing rest and repair and rejuvenation

bull Bridge to recovery

bull Bridge to transplant

Pumps

bull Centrifugal

bull Roller

Membranes

bull Silicone rubber

bull Microporuspolypropylene

bull Polymethyl pentene

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

When Is ECMO Used

bull Support the failing heart and or lungs by temporarily taking over their functions allowing rest and repair and rejuvenation

bull Bridge to recovery

bull Bridge to transplant

Pumps

bull Centrifugal

bull Roller

Membranes

bull Silicone rubber

bull Microporuspolypropylene

bull Polymethyl pentene

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

Pumps

bull Centrifugal

bull Roller

Membranes

bull Silicone rubber

bull Microporuspolypropylene

bull Polymethyl pentene

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

Membranes

bull Silicone rubber

bull Microporuspolypropylene

bull Polymethyl pentene

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

ECMO Cannulae

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

ECMO Machines

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

History of ECMOhellip = hellipHistory of CPB

Pump ndash heart substitute

Gas exchange mechanism ndash Lung Substitute

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

History of ECMOhellip

bull 1953

bull John Heysham Gibbon Jr

bull Jefferson Medical College Hospital (Philadelphia)

bull First successful use of Cardiopulmonary bypass

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

History hellip

bull Atrial Septal Defect Closure

bull Cecelia Bavolek 18F

bull 45 minutes

bull 26 minutes

Next 3 patients died

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

Historyhellip

bull 1954

bull Clarence Walton Lillehei

bull University of Minnesota

bull Controlled cross circulation (VSD Closure 1M child connected to fathers circulation)

bull 19 minutes

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

History helliphellip

bull 1970

bull Theodore Kolobow

bull Membrane Lung (no direct contact between blood and gas)

bull Silicone rubber (Kolobowrsquos orginal)

bull Microporus polypropylene

bull Polymethyl pentene

bull Laminated carbon-containing silicone rubber membrane for use in membrane artificial lung

bull Patent number 4093515bull Abstract A blood-compatible gas-permeable laminated

carbon-containing silicone rubber membrane for use in a membrane artificial lung The membrane is composed of at least two layers wherein the first layer is of silicone rubber compounded with silica filler and the second layer is of silicone rubber compounded with carbon black filler The second layer may be sandwiched between the first layer and a third layer of either silicone rubber compounded with silica filler or filler-free silicone rubber Utilizing such membrane for extracorporeal blood gas exchange in a membrane artifical lung results in elimination of thrombosis without the necessity for maintenance anticoagulant treatment during perfursion and enables elimination of leukopenia and granulocytopenia or inhibition of blood platelet count decreases during perfusion

bull Type Grantbull Filed March 1 1976bull Issued June 6 1978bull Assignee Government of the United Statesbull Inventor Theodor Kolobow

Historyhellip

bull 1972

bull Dr J Donald Hill

bull SanFransisco (CA)

bull First successful adult ECMO

bull 24M Polytrauma with ARDS

History hellip

bull 1975

bull Robert Bartlett

bull Orange County Hospital

Los Angeles CA

bull First successful neonatal ECMO

(I day old Mexican immigrant)

Historyhelliphellip

bull Baby ldquoEsperenzardquo(Baby of hope)

Historyhelliphellip(ELSO Registry 1989)

Historyhelliphellip (Cesar Trial 2006)

BMC Health Serv Res 2006 6 163CESAR conventional ventilatory support vs extracorporeal membrane

oxygenation for severe adult respiratory failureGiles J Peek1 Felicity Clemens2 Diana Elbourne2 Richard Firmin1 Pollyanna

Hardy23 Clare Hibbert5 Hilliary Killer1Miranda Mugford4 MariammaThalanany4 Ravin Tiruvoipati1 Ann Truesdale2 and Andrew Wilson6

An estimated 350 adults develop severe but potentially reversible respiratory failure in the UK annually Current management

History hellip

bull 1975

bull Robert Bartlett

bull Orange County Hospital

Los Angeles CA

bull First successful neonatal ECMO

(I day old Mexican immigrant)

Historyhelliphellip

bull Baby ldquoEsperenzardquo(Baby of hope)

Historyhelliphellip(ELSO Registry 1989)

Historyhelliphellip (Cesar Trial 2006)

BMC Health Serv Res 2006 6 163CESAR conventional ventilatory support vs extracorporeal membrane

oxygenation for severe adult respiratory failureGiles J Peek1 Felicity Clemens2 Diana Elbourne2 Richard Firmin1 Pollyanna

Hardy23 Clare Hibbert5 Hilliary Killer1Miranda Mugford4 MariammaThalanany4 Ravin Tiruvoipati1 Ann Truesdale2 and Andrew Wilson6

An estimated 350 adults develop severe but potentially reversible respiratory failure in the UK annually Current management

Historyhelliphellip

bull Baby ldquoEsperenzardquo(Baby of hope)

Historyhelliphellip(ELSO Registry 1989)

Historyhelliphellip (Cesar Trial 2006)

BMC Health Serv Res 2006 6 163CESAR conventional ventilatory support vs extracorporeal membrane

oxygenation for severe adult respiratory failureGiles J Peek1 Felicity Clemens2 Diana Elbourne2 Richard Firmin1 Pollyanna

Hardy23 Clare Hibbert5 Hilliary Killer1Miranda Mugford4 MariammaThalanany4 Ravin Tiruvoipati1 Ann Truesdale2 and Andrew Wilson6

An estimated 350 adults develop severe but potentially reversible respiratory failure in the UK annually Current management

Historyhelliphellip(ELSO Registry 1989)

Historyhelliphellip (Cesar Trial 2006)

BMC Health Serv Res 2006 6 163CESAR conventional ventilatory support vs extracorporeal membrane

oxygenation for severe adult respiratory failureGiles J Peek1 Felicity Clemens2 Diana Elbourne2 Richard Firmin1 Pollyanna

Hardy23 Clare Hibbert5 Hilliary Killer1Miranda Mugford4 MariammaThalanany4 Ravin Tiruvoipati1 Ann Truesdale2 and Andrew Wilson6

An estimated 350 adults develop severe but potentially reversible respiratory failure in the UK annually Current management

Historyhelliphellip (Cesar Trial 2006)

BMC Health Serv Res 2006 6 163CESAR conventional ventilatory support vs extracorporeal membrane

oxygenation for severe adult respiratory failureGiles J Peek1 Felicity Clemens2 Diana Elbourne2 Richard Firmin1 Pollyanna

Hardy23 Clare Hibbert5 Hilliary Killer1Miranda Mugford4 MariammaThalanany4 Ravin Tiruvoipati1 Ann Truesdale2 and Andrew Wilson6

An estimated 350 adults develop severe but potentially reversible respiratory failure in the UK annually Current management

TYPES OF ECMO

Veno Arterial ECMO (V-A ECMO)

bull Cardiac Support

Veno Venous ECMO (V-V ECMO)

bull Lung Support

Indications for V-A ECMO

bull Inability to wean off CPB after cardiac surgerybull e CPRbull Post MI Cardiogenic shock (refractory to IABP) ndash MR

- VSD- Free wall rupture

- Refractory arrhythmiasbull Post sepsis cardiogenic shockbull Acute viral myocarditisbull Massive bilateral pulmonary embolismbull Cardiac or major vessel blunt traumabull Peripartum cardiomyopathy

Indications for V-V ECMO

bull ARDSbull Massive bilateral extensive pneumoniabull e CPR (drowning)bull Neonates (meconium aspiration HMD)bull Aspiration pneumoniabull Massive lung contusion after chest traumabull Smoke inhalation injurybull Intractable status asthmaticusbull Pulmonary alveolar protienosis (some forms)

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Veno Arterial ECMO (V-A ECMO)

bull Cardiac Support

Veno Venous ECMO (V-V ECMO)

bull Lung Support

Indications for V-A ECMO

bull Inability to wean off CPB after cardiac surgerybull e CPRbull Post MI Cardiogenic shock (refractory to IABP) ndash MR

- VSD- Free wall rupture

- Refractory arrhythmiasbull Post sepsis cardiogenic shockbull Acute viral myocarditisbull Massive bilateral pulmonary embolismbull Cardiac or major vessel blunt traumabull Peripartum cardiomyopathy

Indications for V-V ECMO

bull ARDSbull Massive bilateral extensive pneumoniabull e CPR (drowning)bull Neonates (meconium aspiration HMD)bull Aspiration pneumoniabull Massive lung contusion after chest traumabull Smoke inhalation injurybull Intractable status asthmaticusbull Pulmonary alveolar protienosis (some forms)

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Veno Venous ECMO (V-V ECMO)

bull Lung Support

Indications for V-A ECMO

bull Inability to wean off CPB after cardiac surgerybull e CPRbull Post MI Cardiogenic shock (refractory to IABP) ndash MR

- VSD- Free wall rupture

- Refractory arrhythmiasbull Post sepsis cardiogenic shockbull Acute viral myocarditisbull Massive bilateral pulmonary embolismbull Cardiac or major vessel blunt traumabull Peripartum cardiomyopathy

Indications for V-V ECMO

bull ARDSbull Massive bilateral extensive pneumoniabull e CPR (drowning)bull Neonates (meconium aspiration HMD)bull Aspiration pneumoniabull Massive lung contusion after chest traumabull Smoke inhalation injurybull Intractable status asthmaticusbull Pulmonary alveolar protienosis (some forms)

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Indications for V-A ECMO

bull Inability to wean off CPB after cardiac surgerybull e CPRbull Post MI Cardiogenic shock (refractory to IABP) ndash MR

- VSD- Free wall rupture

- Refractory arrhythmiasbull Post sepsis cardiogenic shockbull Acute viral myocarditisbull Massive bilateral pulmonary embolismbull Cardiac or major vessel blunt traumabull Peripartum cardiomyopathy

Indications for V-V ECMO

bull ARDSbull Massive bilateral extensive pneumoniabull e CPR (drowning)bull Neonates (meconium aspiration HMD)bull Aspiration pneumoniabull Massive lung contusion after chest traumabull Smoke inhalation injurybull Intractable status asthmaticusbull Pulmonary alveolar protienosis (some forms)

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Indications for V-V ECMO

bull ARDSbull Massive bilateral extensive pneumoniabull e CPR (drowning)bull Neonates (meconium aspiration HMD)bull Aspiration pneumoniabull Massive lung contusion after chest traumabull Smoke inhalation injurybull Intractable status asthmaticusbull Pulmonary alveolar protienosis (some forms)

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Criteria for ldquoLung Failure needing ECMOrdquo

bull Murray score gt3 (PaO2FIO2 ratio CXR PEEP Compliance)

bull Hypercarbia pCO2 gt70mm

bull Hypoxia pO2 lt50mm

bull Acidosis pH lt72

bull pAO2 FIO2 ratio lt75

bull Lung compliance lt05ml cmH2O Kg

bull Ventilation index gt40

bull FIO2 requirement of 100 gt6hrs

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Unable to wean off CPB despite optimal inotropes and IABP

bull Cardiac arrest in hospital ( CPRgtgt 30 min)

bull ECHO EF lt20

Aortic velocity time index lt8cm

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Criteria for ldquoCardiac Failure needing ECMOrdquo

bull Systemic index lt18LminM2

bull PCWP gtgt25mm

bull Serum Lactate gt10mmolsL

bull Mixed venous O2 sat ltlt65

bull Inotrope score of gtgt20 (sum of all inotropes in mcgkgmin at peak infusion rate)

bull Mean arterial pressure lt60mm adults (lt40mm infants) for more than 6hrs

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Exclusion Criteria

bull Primary disease is irreversible (disseminated malignancy)

bull Age gt75 years

bull On ventilator gt15 days

bull Irreversible indeterminate neurological prognosis

bull Any immunosupressed state

bull Already in multiorgan failure

bull Pre-existing coagulopathy

bull Severe pulmonary hypertension

bull Severe aortic regurgitation

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

ECMO Management

bull Anticoagulation (around 200 secs)

bull Top up transfusion (platelets RBCs)

bull Sepsis prevention

bull Nutrition

bull Prevent LV distension

bull Monitor recovery

bull Rx of underlying cause

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

How Longhellip

bull ELSO Data 117 days

bull Average V-V ECMO 14-21days

bull V-A ECMO 5-14 days

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Complications

bull Hemolysisbull Thrombocytopenia (mechanical heparin

induced)bull Bleeding bull Sepsis (access site and systemic)bull Intracerebral hemorrhage bull Intracerebral micro infarctsbull Oedemabull Malnutrition hypoalbuminemiabull Limb ischemia

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Results

bull V V ECMO 65-70

bull V A ECMO 50

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Practical Difficulties

bull Very labour intensive

bull Very cost intensive

bull Experienced team

bull Reliable blood bank support 247

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

bull When all else fails helliphelliphellipwhen life is sure to ebb awayhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

bull Cometh the hour helliphelliphelliphellip cometh the man

bull ECMO

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Future of ECMO

bull Increased accessibility and use

bull Reduction in costs

bull Insurance government support

bull Smaller lines volumes oxygenators

bull Coated ldquostealthrdquo tubings

Thank You

Thank You