Chapter 14 - Extracorporeal membrane oxygenation

Summary

Extracorporeal Membrane Oxygenation (ECMO) enables the technology associated with cardiopulmonary bypass to be utilized in the setting of intensive care units. ECMO provides a means of supporting blood gas exchange using a membrane oxygenator. Veno-venous (VV) ECMO is usually used to support patients with respiratory dysfunction, whereas veno-arterial (VA) ECMO is utilized to manage severe cardiac dysfunction with associated impairment of blood gas exchange. The ECMO for adults was pioneered by Bartlett and co-workers in 1988 at the University of Michigan. Cardiac arrest and shock are the common indications for cardiac ECMO support in adults. The circuit tubing and oxygenator are responsible for the inflammatory response that is observed after putting patients on ECMO. Specialist ECMO nurses or perfusionists conduct hourly checks for loose connections, bleeding from cannulation sites and clots within the circuit. They also manage anticoagulation by measuring hourly Activated clotting time (ACT) to titrate the heparin infusion.