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Chapter 23

Chapter 23. Extracorporeal Life Support. Extracorporeal Support. The technique of supporting the function of the heart or lungs, or both, with external artificial organs. History. Gibbon 1937 animals 1953 humans Lillehei 1955 Clowes 1956 Doren 1969 Barlett & Harken 1975.

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Chapter 23

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  1. Chapter 23 Extracorporeal Life Support

  2. Extracorporeal Support The technique of supporting the function of the heart or lungs, or both, with external artificial organs

  3. History Gibbon 1937 animals 1953 humans Lillehei 1955 Clowes 1956 Doren 1969 Barlett & Harken 1975

  4. Neonatal Treatment Persistent pulmonary hypertension of the newborn Meconium aspiration syndrome Sepsis Congenital diaphragmatic hernia

  5. Patient Selection Oxygen index Intraventricular hemorrhage Gestation age Coagulopathy Pulmonary disease Cardiac defects

  6. Pediatric Treatment Research European ECLS experience O’Rourke Weber Swaniker

  7. Venoarterial Route

  8. Venovenous Route

  9. ECLS Circuit

  10. Membrane Oxygenator

  11. Cannulation Consent Blood products Patient positioning Monitor patient and prepare equipment Cannula insertion technique Connect patient to circuit

  12. Management and Monitoring Cardiovascular Anticoagulation Hematologic Neurologic Pulmonary Fluid balance

  13. Weaning Venoarterial Improved lung function Decrease ECLS support; increase ventilator support Intermittent clamp ECLS support Venovenous Increase ventilator support Isolate gas ports from ambient air

  14. Decannulation Sedative and paralytic Infusions to peripheral IVs DC heparin Mirror image of cannulation process

  15. Complications Patient Neurologic Cardiac stun Technical

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