ECMO
Extracorporeal Membrane Oxygenation (ECMO)
Definition: ECMO is temporary support of heart and lung function by partial cardiopulmonary bypass (up to 75% of cardiac output). It is used for patients who have reversible cardiopulmonary failure from pulmonary, cardiac or other disease.
Physiology: Blood is drained from the patient to an external pump which pushes the blood through a membrane gas exchanger (for oxygenation and CO2 removal) and warmed. It returns the blood to the patient’s circulation. This method requires heparin anticoagulation of the patient, that is managed by frequent measurements of activated clotting time (ACT). Various devices monitor pressures, flow, and temperature of the ECMO blood and gas circuits, as well as physiological variables in the patient.
ECMO can be either:
Veno-arterial (VA), in which blood is drained from right atrium (via a right internal jugular venous catheter) and is returned to the thoracic aorta (via a right carotid arterial catheter). VA-ECMO provides cardiac as well as pulmonary support.
Veno-venous (VV), in which blood is drained from right atrium (via side holes of a double lumen catheter) and returned to the right atrium through the end hole of the catheter which is directed towards the tricuspid valve. VV-ECMO requires good cardiac function and avoids cannulation of the carotid artery.
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