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Cards In This Set
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When is ECMO indicated?
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Life threatening forms of Resp. and/or cardiac failure which are unresponsive to conventional treatment.
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Name some common neonatal problems in which call for the use of ECMO.
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-Persistant Pulm. HTN in newborns
-Meconium Aspiration (MAS)
-Sepsis
-Respiratory Distress Syndrome
-Congenital Diaphramatic Hernia
-Total Anomalous Venous Return
-Bridge to Transplant
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What causes PPHN?
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Card. Pulm. disease which increases pulm. vascular resistance. Hypoxia or acidosis causing vasoconstriction to normal pulm. vasc. Decreased area of lung due to hypoplast. Blood bypasses the lungs.
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Describe Congenital Diaphramatic Hernias.
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Diaphram doesn't close by the 8th week of gestation and abdominal organs enter the thoracic cavity. Lungs get compressed and don't develop fully. Also can get cardiac hypoplasia.
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Describe total annomolous pulm. venous return.
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All of the pulm. veins return directly or indirectly (coronary sinus, portal vein, innominate vein) to RA.
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Where is the cannulation for V-A ECMO?
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R Common Carotid
R Internal Jugular
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Describe the ECMO V-A circuit.
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Reservior-Small venous reservior bladder that keeps negative pressure from being applied to RA. Pressure is servoregulated so if it's too negative pump will stop.
Pump-The pump is a roller used with tygon tubing to decrease spallination.
Oxygenator-The oxygenator is an Avecor Silicaon Sheet "True Membrane"
Heat Exchanger- Stainless Steel with blood on inside and water on outside. Placed after oxygenator
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If there is an increased pressure gradient around the oxygenator what could possibly be happening?
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Clotting in oxygenator
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What could possibly be happening if both pressures (before and after oxygenator) are increased?
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Kinked cannula
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What could be happening if both pressures around oxygenator are decreased?
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Decreased pump flow, loss of occlusion
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What does a bridge do in the circuit?
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Connects the arterial and venous lines
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What does a bridge in the ecmo circuit allown for?
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Recirculation of blood when patient is removed from ecmo for trial off. Need to flash the bridge to prevent clotting.
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What are the goals for SvO2 and ACTs?
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SvO2- 60-75%
ACT- 180-220
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What is the difference in adminstering blood products with neonatal and adult ecmo.
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Neonatal you give products through machine. Adults give through IV.
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How often should ACTs be checked on ecmo.
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Every hour or 1/2 hour if unstable
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