ECMO介绍台大医院
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• As a mechanical circulatory support:
– Post-cardiotomy cardiogenic shock – Double bridge (ECMO VAD HTx) – Acute myocarditis – AMI cardiogenic shock (ECPR)
An Example of MCS
HTx
VAD
ECMO
• Different patients • Different situations
Different treatments
Indications of ECMO in the near future
( to prevent ventilator-induced lung injury)
ventilator setting :
PC mode, PEEP >10 , PIP < 35 ,
VR --> PaCO2, FiO2--> PaO2
VA-ECMO
advantage :
1. both lung & heart support 2. higher PaO2
ECMO
extracorporeal membrane oxygenation
(體外膜氧合器) (艾克膜)
(體外維生系統)
ECMO
extracorporeal membrane oxygenation
(Extracorporeal Life Support)
ECMO
prolonged partial cardiopulmonary bypass
ECMO vs CPB
• Veneous reservoir
CPB vs ECMO
CPB
Site
OR
Venous reservoir Yes
Heparin (ACT) >600
Autotransfusion Yes
Hypothermia Yes
Hemolysis
Yes
Hemodilution Yes
for lung
1. support : O2 supply & CO2 removal 2. rest : reduce ventilator induced lung injury
for Leabharlann Baidueart
support : improve systemic perfusion
rest :
↓catecholamine
• Replace CPB:
– Lung transplantation – Neurosurgery – Non-heart-beating-donor support – Rescue for acute pulmonary embolism
• Ventilatory support
– ARDS – Neonatal pulmonary diseases
Arterial filter Yes
ECMO ICU No 120-180 No No No No No
ECMO
• Short-term cardiopulmonary support • Buy time to decide the next step
– Recovery – Transplantation – long-term device (ventricular assist device) – Operation (CABG, pulmonary embolectomy,..) – Give-up
↓myocardial work decrease preload requirement and congestion
ECMO Type
• VV - ECMO • VA - ECMO
VV-ECMO
indication : for lung disease only purpose : to decrease barotrauma