ecmo extracorporeal membrane oxygenarator

ecmo - introduction, types, cannulations, adv, disadv, indication

1. Dr. Vijayanand Palanisamy Consultant – Cardiothoracic surgery Sri Gokulam speciality hospital, salem BASICS of ECMO

2. Cannula Properties Biocompatible Lesser Trauma Easy Insertion Maximum Efficiency Kink Resistance Meet different ‘Therapy Requirements’

3. Membrane Oxygenator Hollow fiber membrane oxygenator Polymethylpentene Heparin-coated High performance CO2 elimination Blood oxygenation Low pressure drop Long duration 15-21 d

4. Heat Exchanger It adjusts the temperature of the perfusate Water circulates within the heat exchanger in a counter current fashion to the flow of blood at temperatures between 1-2°C and 42°C The temperature gradient between the water and blood is kept at 10°C or less

5. Tubing Non-toxic Non-irritant medical grade PVC material Soft and kink resistant tube Phthalate free (DEHP) Coated Tip to Tip.

6. Blood Pumps Electrical Centrifugal pump z 0-5000 RPM Can deliver flows up to 8 L/min High efficiency with lesser RPM Less hemolysis, minimal heat generation

7. Rotaflow II

8. Cardiohelp System

9. Indications - Cardiac Cardiac: Cardiomyopathy Sepsis Perioperative Cardiac Surgery Poisoning ECPR Acute MI Myocarditis Peripartum Cardiomyopathy Decompensated Chronic Heart failure Post cardiotomy shock Toxic drug overdose

10. Indications - Pulmonary Pulmonic: Pneumonia Sepsis ARDS Aspiration Drowning / Trauma Pneumonia Aspiration Pulmonary contusion Toxic inhalation Near-drowning Reperfusion injury ( eg : Post lung transplant) H1N1, MERS…

11. Recent Additions Ventricular Assist Device (VAD) Pump Assisted Lung Protection (PALP/ ECCO2) Minimized Extra corporeal Circulation (MECC) ECMO and Cardiopulmonary Resuscitation (ECPR) Organ Donor Preservation (ODP) Drug abuse / Poisoning / Snake Bite

12. Contraindications Relative Prolonged Mechanical ventilation (>14 days) Severe chronic lung disease Un-witnessed arrest or CPR for 30 minutes Uncontrollable metabolic acidosis Pulmonary fibrosis Immunosuppression Neutrophils - <400 ml/cm3 Severe coagulopathy disorder Absolute Significant neurological injury Active bleeding/coagulation disorder Terminal disease with short life expectancy Cerebral Haemorrhage Genetic Abnormalities (Chromosomal Disorder) Trauma MOF