By Dan M., M.D. Meyer Michael E., M.D. Jessen
This instruction manual is directed at intensivists,surgeons, pediatricians,residents, perfusionists,nurses and ECMO(extracorporeal membrane oxygenation) technologists focused on the care of sufferers with respiration or cardiac failure that can require extracorporeal help. It offers particular info at the mechanics of ECMO, the apparatus required, the body structure of extracorporeal aid, and the administration of sufferers supported on ECMO. present result of ECMO and substitute help ideas also are reviewed in a few chapters of this publication. The authors' aim is to provide clinically necessary details in a way that permits the reader to quickly examine medical events, troubleshoot difficulties, and comprehend the predicted result of remedy.
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Additional resources for Extracorporeal Life Support (Vademecum)
Arterial filter used for adult ECMO (Meditronic®). a) Sterile set-up b) CO2 flush of the circuit c) Displacement of CO2 with crystalloid d) Displacement of crystalloid with blood e) Flow through bridge prior to passing lines to surgeon b. Priming the circuit i. Minimize fluid volume. , Medtronic heat exchanger volume -50 ml). However, components must be of sufficient dimensions to handle the required flow for the individual patient. ii. Priming the circuit—Roller Head Pump Circuit: Neonatal ECMO a) Circuit components selected b) Sterile assembly ECMO centers may either (1) prepare the entire circuits as needed, (2) have a circuit ready at all times, flushed with sterile CO2, or (3) have the circuit flushed with crystalloid (maintains sterility up to 30 days).
Battery replacement (important, as the oxygen analyzer is battery operated). 4. Caveats a. Pressure monitor is a critical component. An increased pressure in one of the gas lines could lead to membrane rupture and air embolus into the ECMO circuit. b. Low pressure may indicate that gas flow is decreased, gas source tubing is disconnected or leaking, or gas source is low or depleted. E. Heat Exchanger 1. Function a. Heat loss via the membrane oxygenator is managed with the heat exchanger. Heat loss comes from the cool sweep gases, the ventilator, from exposed circuit tubing, and the water condensation from the oxygenator.
F. Filtration Devices in ECMO 1. Function An arterial filter (30-40 microns) is usually placed inline between the oxygenator and the reinfusion cannula to trap small emboli of air or debris within the arterial limb of the circuit. As the filter may capture significant volumes of gas, it should always be positioned at the highest point of the ECMO circuit (Fig. 10a, b). 2. Types a. Arterial line filter b. Arterial bubble trap 3. 5 LPM 3 LPM 7 LPM max pressure 300 mmHg 750 mmHg 750 mmHg priming volume 40 ml 100 ml 212 ml normal filter rating 32 microns 40 microns 38 microns 4.