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ECMO

ECMO. Extra Corporeal Membrane Oxygenation. ECMO Indications. Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies Gestational age: 34 weeks or > Weight: 2000 grams or > Predicted mortality: 80% or > A-a gradient (on 100% FIO2): 620 mmhg or >

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ECMO

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  1. ECMO Extra Corporeal Membrane Oxygenation

  2. ECMO Indications • Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies • Gestational age: 34 weeks or > • Weight: 2000 grams or > • Predicted mortality: 80% or > • A-a gradient (on 100% FIO2): 620 mmhg or > • Oxygen Index (OI): 40 or > • OI = (MAP x FIO2) x 100 PaO2

  3. ECMO Techniques Venoarterial • Complete cardiopulmonary bypass • Out: Right atrium via internal jugular • In: Aortic arch via carotid • Requires ligation of one carotid artery!

  4. ECMO Techniques (cont.) Venovenous • Out: right atrium via internal jugular • In: right atrium via femoral vein • Is a lung bypass only technique • No ligation of carotid artery • Newer circuits have a dual lumen catheter so in/out is in right atrium via one vein only

  5. ECMO Circuit

  6. ECMO Management • Circuit must be heparinized, so bleeding potential exists • CO2 may need to be added to blood after it passes through membrane gas exchanger • 80% of cardiac output may initially be bypassed • Patient is weaned to 10% bypass (20 ml/kg/min) • SvO2 is maintained at 75% • Infant is kept on low PIP, PEEP, Rate, and FIO2 while on ECMO

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