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Chapter 14 - Extracorporeal membrane oxygenation

Published online by Cambridge University Press:  15 December 2009

Sunit Ghosh ,
Florian Falter  and
David J. Cook
By
Ashish A. Bartakke  and
Giles J. Peek
Sunit Ghosh
Affiliation:
Papworth Hospital, Cambridge
Florian Falter
Affiliation:
Papworth Hospital, Cambridge
David J. Cook
Affiliation:
Mayo Clinic, Minnesota
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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.

Keywords

cardioplegia delivery systemscardioplegic heat exchangercrystalloid cardioplegia solutionsmyocardial damagemagnetic resonance imagingelectrocardiographyechocardiography
Type
Chapter
Information
Cardiopulmonary Bypass , pp. 176 - 186
Publisher: Cambridge University Press
Print publication year: 2009

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