Draft

43  ECMO

43.1 What this covers

  • Sweep gas flow rate: controls CO2
  • Speed of pump - ECMO Flow rate: controls O2
  • FDo2 Of sweep gas: controls O2

43.2 Learning objectives

  • Sweep gas flow rate: controls CO2
  • Speed of pump - ECMO Flow rate: controls O2
  • FDo2 Of sweep gas: controls O2
  • Inflow and outflow catheters are too close
  • ECMO flow rate is too high.
  • Sweep gas flow interruption: often interruption in equipment, leads to circuit apnea.
  • Membrane lung failure: gas phase or blood phase failure

43.3 Bottom line / summary

  • Basics: https://www.atsjournals.org/doi/full/10.34197/ats-scholar.2020-0077VO
  • Pathologic recirculation: Blood goes from the outflow track (in SVC) back in to IVC and into the inflow track.
  • This leads to ineffective circulation to the body and hypoxemia.
  • Monitor pre- and post- blood gas for
  • What to do with the ventilator?

43.4 Approach

  1. Sweep gas flow rate: controls CO2
  2. Speed of pump - ECMO Flow rate: controls O2
  3. FDo2 Of sweep gas: controls O2
  4. Inflow and outflow catheters are too close
  5. ECMO flow rate is too high.

43.5 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

43.6 Common pitfalls

  • TODO: Capture common errors or missed steps.

43.7 References

  • https://www.atsjournals.org/doi/full/10.34197/ats-scholar.2020-0077VO

43.8 Source notes

43.8.1 ECMO

44 ECMO

Basics: https://www.atsjournals.org/doi/full/10.34197/ats-scholar.2020-0077VO

Variables:

  1. Sweep gas flow rate: controls CO2
  2. Speed of pump - ECMO Flow rate: controls O2
  3. FDo2 Of sweep gas: controls O2

Pathologic recirculation: Blood goes from the outflow track (in SVC) back in to IVC and into the inflow track. This leads to ineffective circulation to the body and hypoxemia. Caused when:

  1. Inflow and outflow catheters are too close
  2. ECMO flow rate is too high.

Monitor pre- and post- blood gas for

  • Sweep gas flow interruption: often interruption in equipment, leads to circuit apnea.
  • Membrane lung failure: gas phase or blood phase failure

What to do with the ventilator?

  • PEEP 10-14, Driving pressure 10-14. Plat <25 then.
  • Fio2 50%, RR 10

Idea: lung rest to lower VILI

44.1 Source materials