flow is adjusted to maintain what values
MAP
sao2
svo2
anatomical venous drain sites
RA appendage
RA (central)
RIJ
fem
anatomical arterial return sites
ascending aorta
aorta (central)
RCCA
fem artery
distal perfusion cannula (DPC)- function
redirects portion blood from main cannula to support distal perfusion
neck cannulation
drain RIJ - RA
return RCCA- aorta
disadvantages
dec intrinsic co (inc svr of ecmo flow)
litigation arteries
coronary arteries perfused in systole (majority blood native = poorly perfused)
arterial air emboli
svo2 goal
65-75%
svo2
mixed venous sat
main value used to eval ecmo
low v high svo2
causes
low
low o2 carrying capacity (hgb)
dec co
inc consumption
high
late sepsis
LV stun
ideal aline
r radial
most accur reflects cerebral perfusion v. fem
higher svo2/pao2- mostly ecmo blood coming from ascending aorta
high pao2
inc ecmo flow at constant native co
dec native co at constant ecmo flow- all ecmo (LV stun)
inc lung function
dec consumption
low pao2
inc consumption
dec lung function
oxygenator failing?
inc pao2 and dec svo2
investigate
dec pao2 and inc svo2
wean
pt pao2 matches post oxy memb pao2
no native co
mixing cloud- def
usually fem/fem cannulation
heart function return b4 lung
LV ejecting deoxygenated blood into ascend aorta
r/f cereb/coronary hypoxia
N/S syndrome- trtmnt
inc flow to try and outcompete native function
cardene (arterial vasodil)
add another drain line
convert to VV
optimize vent fio2
east west syndrome-def
pt awake and inc rr drives down co2, alkalotic blood out aorta to r rad aline
pt blood gas alkalotic
dec sweep to compensate
acidotic blood delivered by ecmo circuit to pt mostly sent to cerebral perfusion- triggers receptors to inc rr further bc elevated co2
only exacerb alkalosis more
east west syndrome- s/s
tachypnea, delerium despite alkalotic abg from r rad aline
and or
increasingly alkalotic abg despite dec sweep gas flow
east west syndrome- trtmnt
titrate sweep gas to post circuit paco2 even if pt abg alkalotic
cardiogenic shock s/s
narrow pp
persistent hypotension
tachycardia
dec uo
pulm and systemic venous congestion
inc cvp
cardiogenic shock dx
CI < 1.8L/min
map <60 or <30 from baseline
dec end organ perfusion
dec uo, inc cr, cool extremeties, lac >2
echo
cxr
cardiogenic shock- etiology
arrhythmias
lv failure
acute mi, myocarditis, cardiomyopathy
rv failure
PE, sepsis, pulm htn
valvular/mechanical dysfunction
aortic regurg
endocarditis
cardiogenic shock- trtmnt meds
diuretics
vasodil
nitroglycerin (venodil)
nitroprusside (vasodil)
vasopressors
inotropes
