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What ECMO IS and IS NOT: Appropriate Patient Selection and Utilization of ECMO

What ECMO IS and IS NOT: Appropriate Patient Selection and Utilization of ECMO. ECMO aka ECLS. ECMO : E xtra c orporeal M embrane O xygenation ECLS : E xtra c orporeal L ife S upport ELSO: Extracorporeal Life Support Organization www. elso .med.umich.edu /. ECLS.

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What ECMO IS and IS NOT: Appropriate Patient Selection and Utilization of ECMO

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  1. What ECMO IS and IS NOT: Appropriate Patient Selection and Utilization of ECMO

  2. ECMO aka ECLS • ECMO: Extracorporeal Membrane Oxygenation • ECLS: Extracorporeal Life Support • ELSO: Extracorporeal Life Support Organization • www.elso.med.umich.edu/

  3. 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

  4. 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

  5. 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

  6. 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

  7. Disease Treated with ECMO • Persistent Pulmonary Hypertension (PPHN) • Meconium Aspiration Syndrome (MAS) • Respiratory Distress Syndrome • Congenital Diaphragmatic Hernia • Sepsis/ Pneumonia • Congenital heart Disease

  8. Cardiomyopathy/myocarditis • ARDS • Aspiration Pneumonia • Pulmonary Embolism

  9. ECMO Is NOT a tool for destination therapy in cases of non-reversible, non-acute injury or illness.

  10. Contraindications:Relative • Conditions incompatible with ‘normal’ life • Preexisting conditions; affect quality of life • CNS Status • End Stage Malignancy • Risk of systemic bleeding with Anticoagulation • Age and Size of Patient • Futility

  11. ECMO IS for acute, reversible injury, diseaseECMO IS NOT for non-reversible, non-acute injury or illness

  12. Neonatal Respiratory • Indications: • Oxygen Index (OI) • OI= Mean Airway P x FiO2 x 100 Post 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

  13. 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

  14. 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

  15. 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

  16. 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 issue

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