What ECMO IS and IS NOT: Appropriate Patient Selection
and Utilization of ECMO
ECMO aka ECLS• ECMO: Extracorporeal Membrane
Oxygenation• ECLS: Extracorporeal Life
Support• ELSO: Extracorporeal Life
Support Organization• www.elso.med.umich.edu/
ECLS• Use of Mechanical Device to
temporarily (days to months) support heart or lung function (partially or totally) during cardiopulmonary failure, leading to organ recovery or replacement
ECMO• Using an oxygenator to support
the cardiac or oxygenation of a patient for and extended period of time
• We still call it ECMO• ECMO does not describe the CO2
removal
History• First used in the 1970s on Adult
Respiratory patients• 1974 first Neonatal Respiratory
ECMO for MAS (Bob Bartlett)• NIH sponsored a study of Adult
Resp. but trial halted after only 90 patients b/c less than 10% survival
• Bartlett went on to treat respiratory distress infants with a 75% survival rate
Why use ECMO?• -Cardiac• -Respiratory• -Both
• “Acute severe heart or lung failure with high mortality risk despite optimal conventional therapy.”
• ECLS considered a 50% mortality risk
Disease Treated with ECMO
• Persistent Pulmonary Hypertension (PPHN)
• Meconium Aspiration Syndrome (MAS)
• Respiratory Distress Syndrome• Congenital Diaphragmatic Hernia• Sepsis/ Pneumonia• Congenital heart Disease
• Cardiomyopathy/myocarditis• ARDS• Aspiration Pneumonia• Pulmonary Embolism
ECMO Is NOT a tool for destination therapy in cases of
non-reversible, non-acute injury or
illness.
Contraindications:Relative
1. Conditions incompatible with ‘normal’ life
2. Preexisting conditions; affect quality of life– CNS Status– End Stage Malignancy– Risk of systemic bleeding with
Anticoagulation3. Age and Size of Patient4. Futility
ECMO IS for acute, reversible injury,
disease
ECMO IS NOT for non-reversible,
non-acute injury or illness
Neonatal Respiratory• Indications:
– Oxygen Index (OI)– OI= Mean Airway P x FiO2
x 100Post Ductal PaO2
– OI=20 Consider ECMO
– OI= 40 ECMO indicated
• Contraindications:– Lethal chromosomal
disorder– Irreversible brain or
organ damage– < 2 kg or < 34
week– Grade III or > IVH
Pediatric Respiratory• Indications:
– No Absolute indications are known• Best within 7 days
of Mechanical Ventilation
• Contraindications:– Neurosurgical
procedure or intracranial bleed within 10 days
– Recent Surgery or trauma
– Severe Neurologic compromise, genetic abnormalities
– Endstage hepatic failure, renal failure, primary PHTN
Cardiac Cases• Indications:
– Post Op failure– ICU: Pressor,
inotropic, Metabolic acidosis, decreased urine output for 6 hours
– Cardiac Arrest– Myocarditis,
myocardiopathy, toxic drug overdose
• Contraindications:– Untreatable
underlying disease
– Futility– CPR ongoing > 5
mins
Adult Respiratory Failure• Indications:
– Hypoxic Resp. Failure• 50% mortality:
PaO2<150 on >90% FiO2 or Murray Score 2-3
• 80% Mortality: PaO2 <80 on FiO2 >90%, Murray Score 3-4
– CO2 Retention PaCO2>80
• Contraindications:– High Vent settings
> 7 days– Major
immunosupprssion• (Neutophil <
400/ml3)– CNS Hemorrhage– Increase mortality
with increase age
Adult Cardiac• Indications:
– Cardiogenic Shock• Acute MI• Myocarditis• Peripartum
Cardiomyopathy• Decompensated
Chronic Heart failure
• Post cardiotomy shock
• Contraindications:– Unrecoverable
heart; not a candidate for transplant or VAD
– Chronic organ dysfunction
– Prolonged CPR– Anticoagulation
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