By Dan M., M.D. Meyer Michael E., M.D. Jessen
This instruction manual is directed at intensivists,surgeons, pediatricians,residents, perfusionists,nurses and ECMO(extracorporeal membrane oxygenation) technologists eager about the care of sufferers with breathing or cardiac failure that may require extracorporeal aid. It presents particular details at the mechanics of ECMO, the gear required, the body structure of extracorporeal help, and the administration of sufferers supported on ECMO. present result of ECMO and substitute aid recommendations also are reviewed in a few chapters of this ebook. The authors' aim is to provide clinically priceless details in a way that permits the reader to quickly check scientific occasions, troubleshoot difficulties, and comprehend the anticipated result of remedy.
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Additional info for Extracorporeal Life Support (Vademecum)
Sample text
Attach 3˝ tubing with straight connectors to the blood inlet and outlet ports of new oxygenator and clamp both tubes iv. Attach 1/4˝ stub to oxygen inlet port and clamp; attach vacuum line to gas exhaust port and clamp v. Place stopcock on recirculation port in OPEN position; attach stopcock on the venous side of luer in OFF position vi. Flush oxygenator with filtered 100% CO2 through venous side luerlock port and exhaust through open stopcock on upper recirculation port for 2-3 minutes at 1-2 lpm gas flow vii.
8. DLVV ECMO cannula. 2. VA vs. 4 In VV ECMO, lower heart rates may result from improvement in the oxygenation, correction of acidosis, and reduction of endogenous and exogenous catecholamines. c. Cardiac contractility Contractility is often described as decreased while on ECMO as Fig. 9. Two-site VV ECMO there is a decrease in left ventricular ejection phase indices and a fall in shortening fraction. 5 d. 4, both right and left sided systolic pressures are damped with full VA ECMO support and conventional pressure indices of cardiac filling are rendered inaccurate.
Vasodilatation later in the ECMO course may be secondary to sepsis or acidosis 2. Fluid requirements a. Initial fluid requirements may be significant, but after stabilization, increased requirements may indicate sepsis, bleeding, or an intraabdominal process such as pancreatitis. b. Capillary leak syndrome often accompanies the onset of ECMO and is again related to the inflammatory response. Pulmonary capillary leak can result in a chest x-ray appearance of near total opacification. Blood volume distribution initially expands to the periphery, but equilibrates over time, unless capillary leak persists.