1. ECMO Extra Corporeal Membrane Oxygenation

2. ECMO Indications Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies Acute, reversible lung and/or cardiac failure that is unresponsive to conventional therapies Gestational age: 34 weeks or > Gestational age: 34 weeks or > Weight: 2000 grams or > Weight: 2000 grams or > Predicted mortality: 80% or > Predicted mortality: 80% or > A-a gradient (on 100% FIO2): 620 mmhg or > A-a gradient (on 100% FIO2): 620 mmhg or > Oxygen Index (OI): 40 or > Oxygen Index (OI): 40 or > OI = (MAP x FIO2) x 100 OI = (MAP x FIO2) x 100 PaO2 PaO2

4. ECMO Techniques Venoarterial Complete cardiopulmonary bypass Out: Right atrium via internal jugular In: Aortic arch via carotid Requires ligation of one carotid artery!

5. ECMO Techniques (cont.) Venovenous Out: right atrium via internal jugular Out: right atrium via internal jugular In: right atrium via femoral vein In: right atrium via femoral vein Is a lung bypass only technique Is a lung bypass only technique No ligation of carotid artery No ligation of carotid artery Newer circuits have a dual lumen catheter so in/out is in right atrium via one vein only Newer circuits have a dual lumen catheter so in/out is in right atrium via one vein only

6. ECMO Circuit

7. ECMO Management Circuit must be heparinized, so bleeding potential exists Circuit must be heparinized, so bleeding potential exists CO2 may need to be added to blood after it passes through membrane gas exchanger CO2 may need to be added to blood after it passes through membrane gas exchanger 80% of cardiac output may initially be bypassed 80% of cardiac output may initially be bypassed Patient is weaned to 10% bypass (20 ml/kg/min) Patient is weaned to 10% bypass (20 ml/kg/min) SvO2 is maintained at 75% SvO2 is maintained at 75% Infant is kept on low PIP, PEEP, Rate, and FIO2 while on ECMO Infant is kept on low PIP, PEEP, Rate, and FIO2 while on ECMO