ECMO introduction.ppt
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ECMO Introduction
台大醫院 外科加護病房
柯文哲 醫師
ECMO Introduction
Dr. Wen-Je Ko
SICU, Department of Surgery
National Taiwan University Hospital
ECMO
extracorporeal membrane oxygenation
(體外膜氧合器)
(艾克膜)
(體外維生系統)
ECMO
extracorporeal membrane oxygenation
(Extracorporeal Life Support)
ECMO
??
prolonged partial cardiopulmonary bypass
ECMO vs CPB
? Veneous reservoir
CPB vs ECMO
ECMO
? Short-term cardiopulmonary support
? Buy time to decide the next step
- Recovery
- Transplantation
- long-term device (ventricular assist device)
- Operation (CABG, pulmonary embolectomy,..)
- Give-up
for lung
1. support : O2 supply & CO2 removal
2. rest : reduce ventilator induced lung injury
for heart
support : improve systemic perfusion
rest :
↓catecholamine
↓myocardial work
decrease preload requirement and congestion
ECMO Type
? VV - ECMO
? VA - ECMO
VV-ECMO
indication : for lung disease only
purpose : to decrease barotrauma
( to prevent ventilator-induced lung injury)
ventilator setting :
PC mode, PEEP >10 , PIP < 35 ,VR --> PaCO2, FiO2--> PaO2
VA-ECMO
advantage :
1. both lung & heart support
2. higher PaO2
An Example of MCS
? Different patients
? Different situations
==> Different treatments
Indications of ECMO in the near future
? As a mechanical circulatory support:
- Post-cardiotomy cardiogenic shock
- Double bridge (ECMO--> VAD--> HTx)
- Acute myocarditis
- AMI cardiogenic shock (ECPR)
? Replace CPB:
- Lung transplantation
- Neurosurgery
- Non-heart-beating-donor support
- Rescue for acute pulmonary embolism
? Ventilatory support
- ARDS
- Neonatal pulmonary diseases
ECMO Introduction
台大醫院 外科加護病房
柯文哲 醫師
ECMO Introduction
Dr. Wen-Je Ko
SICU, Department of Surgery
National Taiwan University Hospital
ECMO
extracorporeal membrane oxygenation
(體外膜氧合器)
(艾克膜)
(體外維生系統)
ECMO
extracorporeal membrane oxygenation
(Extracorporeal Life Support)
ECMO
??
prolonged partial cardiopulmonary bypass
ECMO vs CPB
? Veneous reservoir
CPB vs ECMO
ECMO
? Short-term cardiopulmonary support
? Buy time to decide the next step
- Recovery
- Transplantation
- long-term device (ventricular assist device)
- Operation (CABG, pulmonary embolectomy,..)
- Give-up
for lung
1. support : O2 supply & CO2 removal
2. rest : reduce ventilator induced lung injury
for heart
support : improve systemic perfusion
rest :
↓catecholamine
↓myocardial work
decrease preload requirement and congestion
ECMO Type
? VV - ECMO
? VA - ECMO
VV-ECMO
indication : for lung disease only
purpose : to decrease barotrauma
( to prevent ventilator-induced lung injury)
ventilator setting :
PC mode, PEEP >10 , PIP < 35 ,VR --> PaCO2, FiO2--> PaO2
VA-ECMO
advantage :
1. both lung & heart support
2. higher PaO2
An Example of MCS
? Different patients
? Different situations
==> Different treatments
Indications of ECMO in the near future
? As a mechanical circulatory support:
- Post-cardiotomy cardiogenic shock
- Double bridge (ECMO--> VAD--> HTx)
- Acute myocarditis
- AMI cardiogenic shock (ECPR)
? Replace CPB:
- Lung transplantation
- Neurosurgery
- Non-heart-beating-donor support
- Rescue for acute pulmonary embolism
? Ventilatory support
- ARDS
- Neonatal pulmonary diseases
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