ECMO AT THE U of M
•Two era’s 1974 & 1986
•1974 - 12 patients. Kolobow MembraneLung – Roller Pump – Adult and Peds.Patients. No Survivors
•1986 to present - ? Patients. Severaldifferent oxygenators, Centrifugal pumponly!
•?% overall survival
CIRCIUTS FOR ECMO
•ARTERIAL VENOUS
•VENOVENOUS
•PERIPHERAL
•CENTRAL (OPEN CHEST)
CANNULATION TECHNIQUENEONATE PERIPHERAL
•Neck cannulation
•Positioning of patient
•Sedation
•Surgical Prep
•Ideal Cannulae Position
Ideal Arterial CannulaPlacement A V ECMO
•Cannula in Ascending Aorta just aboveAortic valve (adjacent coronary ostia)
•Supplies oxygenated blood tocoronaries and the rest of thecirculation.
•Cannula tip should avoid proximity withthe Aortic valve leaflets and stay out ofleft ventricle.
SINGLE CANNULAVENOVENOUS
•Dual luman cannula
•Smallest size 14 fr. - limits use topatients above 4 kg.
•15 Fr. – 4kg to < 9kg two lenghts
•Flow recirculation 15-30%
•Requires higher flows
•No lung rest - must ventilate
•Requires good cardiac function
VENEO/VENOUS IN ADULTSPeripheral cannulation
•Drainage from Femoral vein
•Return SVC via Jugular access
(Or visa versa)
•Access may be percutanious or direct cutdown
•Percutanious is better (less bleeding)
•Requires ventilation (no lung rest)
•Requires good cardiac function
VENO/ARTERIAL ADULTS
•Peripheral -Femoral vein, FemoralArtery
–Limited distribution of blood centrally
–Must have reversal of flow in Aorta foroxygenated blood to reach Heart and Brain
–Must place distal perfusion cannula inFemoral artery
•Central cannulation - Aorta, Rt. Atrium
–Complete cardiopulmonary support
