Back to Basics: ECMO

•ECMO (extracorporeal membrane oxygenation) is a form of extracorporeal life support (ECLS)

•Three types:

1.VV = veno-veno (femoral or IJV into RA) -- purely for oxygenation/removal of CO2 as support for severe respiratory failure (no cardiac dysfunction)

2.VA = veno-arterial (FV - pump - membrane - fem artery) -- poor perfusion AND need for circulatory support

3.V-AV (IVC - O2 - pumped into RA and FA): for severely compromised cardiac and pulmonary function

•Indications = acute, severe REVERSIBLE respiratory or cardiac failure with a high risk of death that is refractory to conventional management

•VV: poor gas exchange, low lung compliance, low P:F ratio, increased shunting → e.g., PNA, ARDS, drowning, amniotic fluid/fat/air embolism, etc.

•VA: refractory shock or arrest (e.g., arrest needing PCI, MI+shock, aortic dissection+tamponade, PE+CV collapse), hypothermia with refractory VT, bridge to LVAD

•V-AV: Cardiogenic shock with severely compromised lung function, i.e. pulmonary edema/ARDS

Want to read more about ECMO from EMDaily? Visit our prior posts:

http://www.emdaily.cooperhealth.org/content/respiratory-failure-indicati...

http://www.emdaily.cooperhealth.org/content/you-have-be-warm-and-dead-ec...

Source:

Extracorporeal life support in the emergency department: A narrative review for the emergency physician. Resuscitation. 2018 Dec;133:108-117. doi: 10.1016/j.resuscitation.2018.10.014. Epub 2018 Oct 15.