ECMO (ExtracorporealMembraneOxygenation), in Chinese, is commonly known as ? Yeke Membrane? ECMO (ExtracorporealMembraneOxygenation) Artificial Membrane Lung?
Extracorporeal Membrane Oxygenation (EMO) is a medical emergency device used to provide continuous extracorporeal respiration and circulation to patients with severe cardiorespiratory failure in order to maintain their lives.
Extracorporeal Membrane Lung Oxygenation (English: Extra-corporealMembraneOxygenation, abbreviation: ECMO) is a medical emergency device that is used to provide extracorporeal respiration and circulation to patients during cardiopulmonary surgeries, such as those for severe cardiopulmonary failure and heart transplantation. In addition to temporarily replacing the patient's cardiopulmonary function and reducing the burden on the patient's heart and lungs, ECMO can also buy more time for medical personnel to save the patient's life.
The essence of ECMO is a modified artificial heart-lung machine, the most central part of the membrane lung and blood pump, respectively, play the role of artificial lungs and artificial heart, can be critical cardiopulmonary failure patients with prolonged cardiopulmonary support, for the rescue of critical illnesses to win the precious time. ECMO is currently the most core means of support for severe cardiopulmonary failure, is also known as the critically ill patients? ECMO is the most central support for severe cardiopulmonary failure, and is also known as the "last straw" for critically ill patients. It is a top life-supporting technology that represents the level of critical care in a hospital, a region, and even a country.
ECMO was first invented in the 1950s by John Gibbon, and then by Clarence H. Kennedy. Gibbon, and Clarence Walton, who was the first to use ECMO in the United States. Clarence Walton. Leahy continued to develop ECMO. Due to the early immaturity of purely mechanical external support systems, Lillahay adopted the bold experiment of using a living human as an external support system for the patient, and used it for the first time in a neonate in 1965 to test its efficacy.
In 1972, Dr. Robert H. Barrett, a surgeon at the University of Michigan, developed an in vivo support system for patients. Robert H. Bartlett, a surgeon at the University of Michigan, first successfully used it in the treatment of patients with acute respiratory distress.
The main components of ECMO
The blood pump, oxygenator, gas mixer, heater, various arterial and venous catheters and monitors and other components, of which the blood pump and oxygenator for the core components of the membrane of the Yekatera, the blood pump to play a substitute for the patient's heart, the oxygenator plays a substitute for the function of the lungs.
Medical uses of ECMO
The Extracorporeal Life Support Organization (ELSO) publishes guidelines describing ECMO indications and practices. Criteria for initiating ECMO vary by organization, but typically include acute severe cardiac or pulmonary failure that is likely to be reversible and unresponsive to conventional therapy. Clinical situations that may prompt ECMO initiation include:
1. Hypoxic respiratory failure in which the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2 /FiO2) is less than 100 mmHg despite optimized ventilator settings, including fraction of inspired oxygen (FiO2), positive end-expiratory pressure (PEEP), and inspiratory to expiratory (I:E) ratio.
2. Hypercapnic respiratory failure with arterial pH <7.20.
4. Cardiac arrest.
5, Inability to withdraw from extracorporeal circulation after cardiac surgery.
6, As a bridge to heart transplantation or placement of ventricular assist devices.
7, Bridging lung transplantation.
8. Septic shock is a more controversial issue, but ECMO is being studied more and more
Hypothermia, with a core temperature between 28 and 24?C and an unstable heart, or a core temperature below 24?C.
9. In patients with cardiac arrest or cardiogenic shock, it appears to improve survival and a favorable prognosis.
10, Early studies have shown a survival benefit of using ECMO in patients with acute respiratory failure especially in patients with acute respiratory distress syndrome.
A registry of nearly 51,000 people who have received ECMO, maintained by ELSO, reported the following results: survival rates of 75% for neonatal respiratory failure, 56% for pediatric respiratory failure, and 55% for adult respiratory failure. Other observational and uncontrolled clinical trials have reported survival rates of 50% to 70%.
These reported survival rates are superior to historical survival rates. Even though ECMO is used for a range of diseases with varying mortality rates, early detection is critical to prevent progression and increase survival outcomes.
In the UK, intravenous ECMO deployment is focused on designated ECMO centers to potentially improve care and promote better outcomes.
How ECMO is used
ECMO should only be performed by clinicians trained and experienced in its initiation, maintenance, and deactivation.ECMO administration is usually performed by a registered nurse, respiratory therapist, or perfusionist. Once it is determined that ECMO will be initiated, the patient will be anticoagulated with intravesical heparin to prevent thrombosis from clotting from the oxygenator. Prior to initiation, intravesical heparin is pushed and measured to ensure that the ACT is between 300-350 seconds. Once the ACT is within this range, ECMO can be initiated and the heparin drip started after a maintenance dose.
Cannulation
Cannulas can be placed percutaneously by the Seldinger technique, a relatively straightforward and common method of obtaining vascular access, or they can be surgically removed. To maximize flow and minimize shear stress, a maximal cannula that can be placed in the vessel is used.
ECMO required for complications after cardiac surgery can be placed directly in the appropriate chamber of the heart or great vessels. Central cannulation via lateral open heart surgery allows patients awaiting lung transplantation to remain sedated and ambulatory.
Titration
After cannulation and connection to the ECMO circuit, hemodynamic parameters and physical examination can be used to determine the appropriate blood flow through the ECMO circuit. The goal of maintaining end-organ perfusion through the ECMO circuit is balanced with adequate physiologic blood flow through the heart to prevent stasis and subsequent clot formation.