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EXTRACORPOREAL MEMBRANE OXYGENATION �IN ADULTS

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Allison Dupont, MD, FACC, FSCAI

Northside Hospital Cardiovascular Institute

ECMO Program and CCU Medical Director

Northside Hospital Gwinnett

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VENOVENOUS (VV) VS. VENOARTERIAL (VA) ECMO

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CARDIOHELP

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V-V ECMO INDICATIONS (ELSO)

1. Refractory acute hypoxemic respiratory failure due to any cause

2. CO2 retention on mechanical ventilation despite high Pplat (ECCO2R)

3. Severe air leak syndromes (eg. broncho-pleural fistula)

4. Acute on chronic respiratory failure in a patient on lung transplant list

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VA ECMO INDICATIONS

  • Right ventricular shock (eg. massive PE, inferior infarct)
  • LV ventricular shock (eg. acute MI shock, Takotsubo cardiomyopathy, acute myocarditis, peripartum cardiomyopathy)
  • Biventricular shock
  • ECPR (not standard of care)

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ECMO can NOT support patients with purely vasodilatory or hemorrhagic shock.

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V-A (VENO-ARTERIAL) ECMO

Provides gas exchange and circulatory support

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Indications:

    • Cardiogenic shock (acute MI, refractory VT, acute MR)
    • Viral myocarditis
    • Acute PE with RV failure
    • Post-cardiotomy circulatory failure
    • ECPR

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V-V (VENO-VENOUS) ECMO

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ECMO CONTRAINDICATIONS

  • Refusal of blood products
  • Prolonged CPR or significant “down time” with no bystander CPR)
  • Intracranial hemorrhage that is recent or expanding
  • Irreversible disease in a patient who is not a transplant candidate
  • Multi-organ failure
  • Severe or irreversible brain injury
  • Age > 70
  • Malignancy or other terminal illness

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POTENTIAL COMPLICATIONS

  • Bleeding
  • Hemolysis
  • Thrombosis
  • Decannulation
  • Infection
  • Intracranial hemorrhage
  • Circuit failure
  • Air embolus
  • Limb ischemia
  • Failure to wean

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PAST 5 YEARS IN THE U.S.

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ECMO REFERRALS

  • ECMO for cardiogenic shock or acute respiratory failure in a non-coding patient is feasible at Atlanta, Forsyth, Cherokee and Duluth campuses.

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  • Cannulation for ECPR in the setting of refractory cardiac arrest must be achievable within 60 minutes of initial arrest and is not feasible at Atlanta, Forsyth, Cherokee and Duluth campuses.

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  • Once ROSC is achieved, ECMO can be considered in cases in which there are no contraindications.

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�NORTHSIDE GWINNETT TRANSFER LINE: (855)662-6625��ALLISON.DUPONT@NORTHSIDE.COM