ECMO Basics
Which organ is targeted when a patient is being considered for VV-ECMO?
Lungs
To increase delivery of oxygen in a VV-ECMO, providers would primarily increase this setting.
Blood flow rate
This is the most common complication associated with ECMO.
Bleeding
This set of rhythms when presented initially in refractory cardiac arrest show favorable outcomes in eCPR
Shockable rhythms (Vtach and Vfib)
This describes the use of VA-ECMO in an emergency setting to resuscitate a patient in cardiac arrest, providing a bridge to diagnosis and interventions like PCI or cardiac surgery.
eCPR
This type of ECMO provides both respiratory and cardiac support.
VA-ECMO
This phenomenon seen only in VV-ECMO describes an event where a significant portion of the re-infused oxygenated blood is immediately captured by the drainage cannula leading to inefficient systemic oxygenation.
Recirculation
To mitigate distal limb ischemia in a patient with femoral arterial cannulation for VA-ECMO, this type of ancillary cannula/catheter is often placed to provide antegrade flow to that leg.
Distal perfusion cannula/catheter
This device is currently approved for use in in-house cardiac arrest when eCPR has been activated to assist in maintaining a sterile field for cannulation and decrease compressor fatigue.
LUCAS
In VV-ECMO, a patient with dual lumen cannula, a chest X-ray or US imaging showing the re-infusion port aimed directly at this cardiac structure is a major factor in preventing recirculation and systemic hypoxemia.
tricuspid valve
This is responsible for the gas exchange part also known as the “artificial membrane” or the “artificial lung”.
Oxygenator
Prior to initiating a Ramp Study in VA-ECMO, it is important to address what specific lab value to the ECMO team?
PTT
Hemolysis, defined as the destruction of RBC’s caused by mechanical stress, pump thrombosis, or high circuit resistance resulting in elevated LDH and plasma free Hgb can lead to what type of organ dysfunction.
Kidney failure
Currently, HUMCs eCPR guidelines include patients up to what age cutoff?
70 years old
This refers to the binding and loss of drugs within the extracorporeal circuit, which can significantly reduce plasma drug concentrations and lead to therapeutic drug failure.
Sequestration
This type of cannula only used in VV-ECMO has single cannulation site and allows for enhanced patient mobility.
Dual lumen cannula (Avalon, Crescent)
This is the pressure being measured within the oxygenator to monitor for clot build-up, and eventually compromised oxygenator function.
Delta P
Seen in femoral or peripheral VA-ECMO wherein de-oxygenated blood from the unrecovered lungs is being pumped by the heart to the upper body while oxygenated ECMO blood perfuses the lower body.
Harlequin syndrome, North-South syndrome, Differnetial Hypoxia
This 2020 randomized trial was a major win for ECPR, showing a striking 43% good neurological survival in the ECPR group versus 0% in the standard care group, leading to its early termination for efficacy.
The ARREST Trial
When a patient on ECMO develops Heparin-induced thrombocytopenia (HIT), Bivalirudin or Argatroban is used to replace Heparin. These medications belong to what class of anticoagulants?
Direct Thrombin Inhibitors (DTI)
What is considered the most difficult type of ECMO with the lowest survival rate?
eCPR
This process is the standard method of assessing readiness for weaning and decannulation from VV-ECMO. It involves turning off the sweep gas flow to the oxygenator while maintaining ECMO blood flow.
Sweep gas off trial, sweep off trial
This type of neurologic complication is considered the most catastrophic and is associated with a very high mortality rate if not a severe, permanent long term disability for survivors.
intracranial hemorrhage
Elevated levels of this specific enzyme, a biomarker for neuronal injury, in the blood of a post-arrest patient are associated with a worse neurological prognosis.
Neuron-specific Enolase
This hybrid ECMO configuration, which involves draining from the venous system and re-infusing directly into the pulmonary artery is used to support a failing right ventricle.
V-PA (Veno-pulmonary artery) ECMO or Oxy-RVAD