ECMO

Tomanya Kenneth Kakuru

Resident One
12th April 2019
 Outline
• ARDS - recap

• Definition

• Mechanism

• Indications and contraindications

• Complications
Case scenario
 Case scenario
• 70/M, NL, 3 time Formula 1 world champion, suffered severe crash
1976. Smoke inhalational injury.

• 2018: suffered pneumonia with hemorrhagic alveolitis. ARDS.

• Placed on ECMO as he awaited long transplant

• 2019 : Recovering well.

 ARDS
The Berlin Definition (2013)
• acute, with onset over 1 week or less

• bilateral opacities consistent with pulmonary edema

• PF ratio <300mmHg with a minimum of 5 cmH20 PEEP

• must not be  fully explained by cardiac failure or fluid overload

 ARDS

ARDS Severity   PaO2/FiO2*   Mortality** 

Mild 200 – 300 27%

Moderate 100 – 200 32%

Severe < 100 45%

 ARDS
• Mechanical Ventilation: proning, Recruitment Manouevres

• inhaled iNO

• inhaled prostacycline

• ECMO
 ECMO - Definitions

ECMO terminology is used for modalities providing pulmonary support

system involving oxygenation and carbon dioxide removal
ECMO – Mechanism
ECMO – Mechanism
 ECMO- Indications
• Remove CO 2 and oxygenate the blood

• Improve tissue oxygen delivery

• Allow normal physiologic metabolic milieu at tissue level

• Provide lung rest and/or cardiac offloading

 ECMO – Contraindications
Absolute Relative
• progressive non-recoverable • age > 75
cardiac disease • multi-trauma with multiple
• progressive and non-recoverable bleeding sites
respiratory disease • CPR > 60 minutes
• chronic severe pulmonary • multiple organ failure
hypertension
• CNS injury
• advanced Malignancy
• unwitnessed cardiac arrest
 ECMO – complications
• Machine and equipment

• Cardiovascular

• Respiratory

• Hematologic
 ECMO – worth it?
• 55% survival for adult respiratory failure.

• Other observational and uncontrolled clinical trials have reported

survival rates from 50 to 70%
 References
• https://lifeinthefastlane.com/ccc/ecmo/
• Sandeep chauwun , Annals of cardiac anaesthesia,
2011,Extracorporeal membrane oxygenation, an anesthesiologist's
perspective: Physiology and principles.