extracorporeal membrane oxygenation definition definition cardiopulmonary bypasscardiopulmonary...
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Extracorporeal Membrane Extracorporeal Membrane OxygenationOxygenation
DefinitionDefinition• Cardiopulmonary BypassCardiopulmonary Bypass• Pulmonary supportPulmonary support• Cardiac supportCardiac support
OutcomesOutcomes• InternationalInternational• CCHMCCCHMC
IndicationsIndications
Meconium Aspiration SyndromeMeconium Aspiration Syndrome Persistent Pulmonary Hypertention of Persistent Pulmonary Hypertention of
the Newbornthe Newborn Sepsis/pneumoniaSepsis/pneumonia Respiratory Distress SyndromeRespiratory Distress Syndrome Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia Congenital Heart DiseaseCongenital Heart Disease
CriteriaCriteria
Weight greater than 1.8-2 kilogramsWeight greater than 1.8-2 kilograms At least 34 weeks gestationAt least 34 weeks gestation Less than 7 days mechanical Less than 7 days mechanical
ventilationventilation IVH less than grade IIIVH less than grade II Failure of maximal medical Failure of maximal medical
managementmanagement Potentially reversible lung diseasePotentially reversible lung disease
PersonnelPersonnel ECMO TeamECMO Team
• AttendingAttending• FellowsFellows• Patient care providerPatient care provider• ECMO specialistECMO specialist• ECMO primerECMO primer
Hospital ServicesHospital Services• UltrasoundUltrasound• CardiologyCardiology• NephrologyNephrology• NeurologyNeurology• Operating room staffOperating room staff
Circuit LayoutCircuit Layout
ProcessProcess
Cannula PlacementCannula Placement• Veno-arterialVeno-arterial• Veno-venousVeno-venous
ECMO flows ECMO flows Heparinization Heparinization
• Activated Clotting TimeActivated Clotting Time• Blood ProductsBlood Products
Respiratory SupportRespiratory Support
ECMO CartECMO Cart
Bladder BoxBladder Box
Cobe PumpCobe Pump
Membrane OxygenatorMembrane Oxygenator
Heat ExchangerHeat Exchanger
CDICDI
RolesRoles
Patient Care ProviderPatient Care Provider• RN who cares for the patientRN who cares for the patient
ECMO SpecialistECMO Specialist• RN or RRT who has received special educationRN or RRT who has received special education• Responsible for the ECMO machine and Responsible for the ECMO machine and
managementmanagement ECMO PrimerECMO Primer
• ECMO specialist who has received further ECMO specialist who has received further training and is able to prepare the ECMO circuittraining and is able to prepare the ECMO circuit
Before going on ECMOBefore going on ECMO
Draw labs - includes type and crossDraw labs - includes type and cross Order blood productsOrder blood products Obtain consent from familyObtain consent from family Prepare ECMO circuit (ECMO Primer)Prepare ECMO circuit (ECMO Primer) Draw up code drugsDraw up code drugs IV AccessIV Access
During CannulationDuring Cannulation
Administer meds as ordered for Administer meds as ordered for pain/sedation/paralysispain/sedation/paralysis
Monitor the patient as you would for Monitor the patient as you would for any bedside surgical procedureany bedside surgical procedure• Frequent vital signs - especially blood Frequent vital signs - especially blood
pressure (may need to give volume)pressure (may need to give volume) Have access to a stable IV site. You Have access to a stable IV site. You
will be asked to give the loading dose will be asked to give the loading dose of Heparin at some point during the of Heparin at some point during the surgery. surgery.
Obtain CXR once cannulas are placedObtain CXR once cannulas are placed
During RunDuring Run
Switch all IV drips to ECMO circuit Switch all IV drips to ECMO circuit CVC CareCVC Care Medication/blood product administrationMedication/blood product administration Double check everything with the ECMO Double check everything with the ECMO
specialist.specialist. Cannula site care. Done Q4hrs. Cannula site care. Done Q4hrs.
• Wash site with 1/2 strength HWash site with 1/2 strength H22OO22, , • Apply betadine ointmentApply betadine ointment• Cover with sterile 4x3.Cover with sterile 4x3.
Physical care of the patientPhysical care of the patient Lab drawsLab draws
DecannulationDecannulation
Obtain IV access if needed. Move all drips Obtain IV access if needed. Move all drips to the patient before clamping.to the patient before clamping.
Draw up code drugsDraw up code drugs Will continue the Heparin drip until the Will continue the Heparin drip until the
final decision has been made to final decision has been made to decannulate.decannulate.
Obtain consent for decannulation.Obtain consent for decannulation. Give meds for pain/sedation/paralysisGive meds for pain/sedation/paralysis Usually continue Cannula site care for 24 Usually continue Cannula site care for 24
hours after coming off ECMOhours after coming off ECMO
Emergency CareEmergency Care If the patient needs to be removed emergently If the patient needs to be removed emergently
from ECMO due to mechanical failure, there are from ECMO due to mechanical failure, there are several things you can do. You should have been several things you can do. You should have been shown how to take the patient off ECMO using V-shown how to take the patient off ECMO using V-B-A. Clamp the Venous cannula, open the Bridge, B-A. Clamp the Venous cannula, open the Bridge, clamp the Arterial cannula.clamp the Arterial cannula.
Call for assistance.Call for assistance. Manage the patient, You will need to ventilate Manage the patient, You will need to ventilate
(increase vent support or handbag). Administer (increase vent support or handbag). Administer meds/fluids as needed.meds/fluids as needed.
Have someone available to get needed supplies.Have someone available to get needed supplies.
ComplicationsComplications Bleeding/HemorrhageBleeding/Hemorrhage Reperfusion injuriesReperfusion injuries Inability to weanInability to wean Mechanical failureMechanical failure Electrolyte ImbalanceElectrolyte Imbalance EdemaEdema Renal FailureRenal Failure HypovolemiaHypovolemia HypertensionHypertension