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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

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