A brief overview of ECMO (Extra Corporeal Membrane Oxygenation)

CRAIG FARRINGTON RN DIP CCN 29/10/13

Overview

DefinitionIndicationsHistoryClinical outcomes

Definition

“(ECMO) a technique of providing respiratory and cardiac support; the blood is circulated through an artificial lung consisting of two compartments separated by a gas-permeable membrane, with the blood on one side and the ventilating gas on the other. It was originally used exclusively in newborns but is now being used more and more in adults.”

Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003

Basic Schematic

Indications

Hypoxemic respiratory failure with a ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2) of <100 mmHg despite optimization of the ventilator settings (PEEP, FiO2)

Hypercapnic respiratory failure with an arterial pH <7.20 Refractory cardiogenic shock Cardiac arrest Failure to wean from cardiopulmonary bypass after cardiac surgery As a bridge to either cardiac transplantation or placement of a

ventricular assist device

ECMO has it's origins in Cardiac surgery

Heart/Lung bypass technique established by John Gibbon,1953 – Support time < 5 hours

First efficicent membrane oxygenators used in 1957 (Kammermeyer)

Steady improvement in membrane technology in 60's

First VA support 1972 - 3 days support

Issues with ECMO

ThrombocytopeniaCoagulopathyHaemolysis Generalized edema, and Deterioration of organ function

Reducing Haemolysis and prolonging support time

Reducing Haemolysis and prolonging support time

Reducing Haemolysis and prolonging support time

Centrifugal

Roller Pump

Modern Polymethylpentene Membranes are now approved for up to 14days continuous use. 

Australian Experience - Swine 'flu 2009 

Sixty-eight patients with severe influenza-associated ARDS were treated with ECMO, of whom 61 had either confirmed 2009 influenza A(H1N1)

The 68 patients who received ECMO had a median range age of 34.4 (26.6-43.1) years and 34 patients (50%) were men ..

The median duration of ECMO support was 10 (7-15) days.

At the time of reporting, 48 of the 68 patients (71%; 95% confidence interval [CI], 60%-82%) had survived to ICU discharge.

Australian Experience - Alfred study.

"Factors associated with outcomes of patients onextracorporeal membrane oxygenation support:a 5-year cohort study"Cecile Aubron1, Allen C Cheng, David Pilcher, Tim Leong, Geoff Magrin,  Jamie Cooper, Carlos Scheinkestell and Vince Pellegrino.

Outcome: The overall mortality was 37.3% (37.1% for the patients who underwent VA ECMO, and 37.7% for the patients who underwent VV ECMO)Study was based on 151 patients tx from 2005-2011most frequent complications during ECMO support were bleeding and bloodstream infections regardless of ECMO type. 

Questions?