Extracorporeal Membrane Oxygenation (ECMO) - Basics
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Description

Extracorporeal Membrane Oxygenation (ECMO) - Basics
Mode of cardiopulmonary support used to treat pulmonary and/or cardiovascular failure with an external artificial circuit
ECMO GOALS:
 • Maintain adequate tissue oxygenation to allow recovery from potentially reversible cardiopulmonary failure
 • Adjust ventilator settings with very low tidal volumes, allowing for lung rest, minimizing further ventilator-induced lung injury
 • ECMO is a bridge, not a destination
Veno-Arterial (VA)
 • Supports heart and lungs (complete cardiopulmonary support)
 • Blood drains - venous system
 • Blood returns - arterial system
Veno-Venous (VV)
 • Suppots lungs (pulmonary support only)
 • Blood drains - venous system
 • Blood returns - venous system
E-CPR
 • Rapid deployment of VA-ECMO when CPR is unsuccessful in achieving sustained return of spontaneous circulation
PARAMETERS
Flow (mL/kg/min):
 • Dial in RPMs and flow depends on resistance in patient & circuit
 • Generally set between 4-6 Lmin (100-150 mL/kg/min in children)
 • On VA-ECMO - flow supports cardiac output
 • On VV-ECMO - flow supports oxygenation
Sweep (L/min): Sweep gas flow determines PCO2 clearance (ie, ventilation) for both VV- & VA-ECMO
OXYGEN DELIVERY
 • From both lungs & oxygenator
 • Assess perfusion (eg, NIRS, SVO2, lactate)
REST SETTINGS
 • If ventilated, frequently placed on low "rest" settings with moderate PEEP
 • Bronchoscopy may be needed for plugging
ANTICOAGULATION
 • To reduce risk of thromboembolism in circuit
 • Done per institutional protocol
ELECTROLYTE REPLACEMENT
 • Particularly Ca+ due to citrate binding

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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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