ECMO

Question 1

What is ECMO

Answer 1

Extracorporeal Membrane Oxygenetion
- Provides prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provided an adequate amount of gas exchange or perfusion to sustain life

Question 2

Difference between ECMO, ECLS, and ELSO

Answer 2

ECMO = actual device 
ECLS  = Extracorporeal life support (put on ECLS vis ECMO) 
ELSO = Extracorporeal life support organization - VGH is a hospital that ELSO to patients on ECMO

Question 3

What is ECMO categorized by? What are the 2 types

Answer 3

According to the circuit used
Veno-Venous
Veno-arterial

Question 4

How does Veno-venous ECMO work? Does it support lung or heart function?

Answer 4

Venous blood is extracted and returned through the venous side of patients circulation. Supports lung function

Question 5

How does Veno-arterial ECMO work? Does it support lung or heart function?

Answer 5

Blood is extracted and returned to the arterial side of the patients circulation. Supports lung and heart function (even if they only need cardiac)

Question 6

What are 3 patient types on ECMO

Answer 6

1. bridge to transplant
2. Bridge to recover
3. Bridge to decision

Question 7

What are the 2 types of Cannula

Answer 7

Single Lumen

Bi-caval (Avalon)

Question 8

What does single lumen require

Answer 8

Femoral access - limits mobility

Question 9

Do you have more flow in a single or bicaval lumen?

Answer 9

Single - People who are really sick will need this

Question 10

Avalon is only used for

Answer 10

Veno-venous support

Question 11

is blood 100% saturated with oxygen in VV ECMO?Why?

Answer 11

no - blood enters body and gets pumped to lungs where it is mixed with deoxygenated- ends up being 80% saturated

Question 12

With what type of ECMO is there risk of cardiac arrest? why?

Answer 12

VA

Pushing it retrograde all the way to aorta

Question 13

What are important logistical considerations for mobilizing with ECMO

Answer 13

• Have a clear goal of the therapy session
• Check the fixations of the cannulas, check for clots in the circuit
• Have complete visual of circuit
• Set up room, position the ECMO cart/vent where you need them
• inform the patient
• Adequate staffing and clear roles: RT, RN, perfusion, PT
• Contingency plan

Question 14

When should you start mobilizing on ECMO

Answer 14

Earlier the better (greater weakness with prolonged bed rest) following screening and troubleshooting