Extracorporeal Membrane Oxygenation

Published on 10/03/2015 by admin

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Chapter 13 Extracorporeal Membrane Oxygenation

Michael G. Fitzsimons, MD, FCCP , Michael N.Andrawes, MD

1 What is extracorporeal membrane oxygenation (ECMO)?

ECMO is a means to provide peripheral oxygenation, ventilation, and circulation to a variety of patients with diseases of the heart and/or lungs for periods of days or weeks. The lungs of patients with severe respiratory failure have an impaired ability to perform the necessary functions of the thoracic cavity, primarily oxygenation and ventilation. Data show that patients with respiratory failure who cannot receive oxygenation or ventilation adequately with use of low tidal volumes without high plateau pressures can be treated with ECMO successfully. Certain patients with hemodynamic failure who lack the ability to meet the metabolic demands of the organs of the body despite pharmacologic support may also benefit from ECMO.

2 What is the history of ECMO?

ECMO was developed as an extension of cardiopulmonary bypass. The first reported use of ECMO for respiratory failure in an adult patient was reported in 1972 in a young man with adult respiratory distress syndrome after a motor vehicle accident. This was followed in 1976 by the first use of ECMO in neonatal patients. Since its development ECMO has been shown to improve survival in neonates with respiratory failure from a variety of causes compared with more traditional therapy. The benefits in adult patients are more controversial.

3 How is ECMO different from cardiopulmonary bypass?

Cardiopulmonary bypass was developed as a means to provide short-term support to patients undergoing cardiac surgery. The setup necessary for cardiopulmonary bypass is also designed to accomplish several other tasks including suction and venting of the field and cardiac chambers and administration of cardioplegia (Table 13-1).

Table 13-1 Differences and Similarities Between ECMO and Cardiopulmonary Bypass

Parameter ECMO Cardiopulmonary Bypass
Oxygenation Yes Yes
Ventilation Yes Yes
Circulatory support Yes Yes
Venous reservoir No Yes
Ability to deliver cardioplegia No Yes
Ability to administer medications into circuit No Yes
Supplemental pumps (e.g., suction, vent) No Yes
Heating and cooling Yes Yes
Ability to adjust oxygenation Yes Yes
Ability to add fluids directly to circuit No Yes
Ability to administer anesthetics in line No Yes

4 What are clinical situations where ECMO may be beneficial?

ECMO has been used for the short-term hemodynamic and respiratory support for numerous conditions (Box 13-1).

Box 13-1 Potential Clinical Uses of ECMO

image Adult respiratory distress syndrome

image Acute respiratory failure associated with viral infection

image Bridge to heart transplantation

image Bridge to lung transplantation

image Acute massive pulmonary emboli

image Primary graft failure after heart transplantation

image Right ventricular failure after heart transplantation

image Severe refractory status asthmaticus

image Low cardiac output syndrome after cardiopulmonary bypass

image Support during liver transplantation

image Hemodynamics and respiratory support during surgery for mediastinal mass excision

image Support during carinal resection

image Support during high-risk percutaneous coronary interventions

image Support during high-risk electrophysiology procedures

image Burn-associated respiratory failure

image Respiratory failure due to near drowning

image Respiratory support for congenital diaphragmatic hernia

image Rewarming after accidental hypothermia

image Reexpansion pulmonary edema

image Severe myocarditis

image Post obstructive pulmonary edema

image Pancreatitis

image Fat emboli syndrome

image Amniotic fluid embolism

image Drug overdose

5 Are there any diagnostic modalities that may indicate when emergent ECMO is indicated?

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