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Ex Life Support
Harry Hoerr; Extracorporeal life support
| Question | Answer |
|---|---|
| How is Extracorporeal life support different from CPB? | -Utilization of Extrathoracic Cannulation -Provides Long Term Support -Allows for intrinsic recovery of lungs and/or heart. |
| What are the general indication for use of extracorporeal life support? | -Patients not responding to optimal. -Patient is newborn past 34 WEEKS gestation. -Patient with treatable/reversible pulmonary disease of less than five days duration. |
| What are some consequences of acute respiratory distress syndrome? | -Increased vascular permeability. -Loss of diffusion. -Surfactant abnormalities. -Tissue destruction (scarring and chronic disease) |
| How is acute respiratory distress syndrome treated? | -No Definitive treatment. -Ventilation. -Steroid Therapy. -Surfactant treatment. -Nitric oxide thearpy. -Liquid Ventilation w/ Perflurocarbons. -ECMO |
| When was the first reported clinical use of a membrane oxygenator? | 1956 |
| Wat class of patients has the highest survival while on respiratory support? (Neonatal, Pediatric, or Adult) | Neonatal (76%) |
| What are some major indications for neonatal ECMO? | -Meconium aspiration -Persistent fetal circulation (PFC) -Persistant pulmonary hypertension -Congenital diaphragmatic hernia -Sepsis -Asphyxia |
| What are the common mechanisms or respiratory failure in neonates? | -Pulmonary artery hypertension. -Persistant fetal circulation. |
| What does hypoxia, hypercarbia, and acidosis create? | Pulmonary hypertension (vasoconstriction) |
| What does vasoconstriction create? | It creates a R-to-L shunt at the atrial, ductal, intrapulmonary levels |
| What is the conventional treatment of pulmonary hypertension? | -Mechanical ventilation with paralysis; induced respiratory alkalosis. |
| What is the neonatal selection criteria for going on ECMO? | -Older then 34 weeks. -Birth weight >2000gm. -No significant coagulopathy or uncontrolled bleeding. -No major intercranial hemorrhage. -Mechanical ventilation of 10 to 14 days or less. -REVERSIBLE lung injury. -No lethal congenital defects |
| What are some indications for pediatric/Adult ECMO? | -Acute, potetially lethal respiratory failure that does not respond to conventional therapy. |
| What are some indications for ADULT ECMO? | -Failure of optimal conventional therapy. -Transplmonary shunt >30%/ -Static lung compliance <0.5 mL/cm H2O/kg. -Diffuse abnormal chest x-ray findings. -Cardiac failure or cardiac arrest. |
| What are some contraindications for ADULT ECMO? | -Above 60 year of age. -Mechanical ventilation more than 5-7 days. -Incurable condition. -Potential for severe bleeding (patients on heparin). |
| What is the cannulation sites for Venoarterial ECMO? | Venous Return-Right Jugular Vein into the R atrium. Arterial Return-R carotid artery into aortic arch. |
| What is the cannulation sites for Venovenous ECMO? | -Usually use double-lumen cannula placed via right jugular vein into the right atrium. -Desaturated blood- Outer Lumen. -Oxygenated Blood- Iner lumen w/ flow directed toward the tricuspid valve |
| What is the ACT range for someone on ECMO? | 180 - 240 sec |
| At what percentage do you ventilate a patient on ECMO? (what is there FiO2 set at)? | between 21% to 30% |
Created by:
allievisner2
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