Brian Locke

ECMO

Basics: https://www.atsjournals.org/doi/full/10.34197/ats-scholar.2020-0077VO

Variables:

  1. Sweep gas flow rate: controls CO2
  2. Speed of pump - ECMO Flow rate: controls O2
  3. FDo2 Of sweep gas: controls O2

Pathologic recirculation: Blood goes from the outflow track (in SVC) back in to IVC and into the inflow track. This leads to ineffective circulation to the body and hypoxemia. Caused when:

  1. Inflow and outflow catheters are too close
  2. ECMO flow rate is too high.

Monitor pre- and post- blood gas for

  • Sweep gas flow interruption: often interruption in equipment, leads to circuit apnea.
  • Membrane lung failure: gas phase or blood phase failure

What to do with the ventilator?

  • PEEP 10-14, Driving pressure 10-14. Plat <25 then.
  • Fio2 50%, RR 10

Idea: lung rest to lower VILI