Description
Extracorporeal membrane oxygenation (ECMO) is a life-support technique used when a person's heart or lungs are severely compromised and cannot provide adequate oxygenation to the body's organs. It involves temporarily diverting a portion of the blood outside the body to a machine that oxygenates it and removes carbon dioxide before returning it to the bloodstream. ECMO is utilized in critical situations like severe respiratory distress syndrome, heart failure, or during certain surgeries, allowing the heart and lungs to rest and recover. While ECMO can provide life-saving support, it is typically used as a last resort due to its complexity and potential risks.
Summary Listen
- Cardiogenic shock is defined by impaired myocardial performance, leading to decreased cardiac output, organ hypoperfusion, and hypoxia. Diagnostic criteria involve hypotension unresponsive to volume resuscitation, along with evidence of end-organ hypoperfusion such as decreased urine output and altered mental status. Early recognition and intervention are critical due to high mortality rates.
- Treatment emphasizes rapid assessment, hemodynamic support, and addressing underlying causes. Initial management involves oxygen supplementation, intravenous access, and correction of reversible issues like electrolyte imbalances. Hemodynamic goals include maintaining a mean arterial pressure (MAP) above 60 mmHg and ensuring adequate urine output.
- Extracorporeal Membrane Oxygenation (ECMO) plays a crucial role in persistent, drug-resistant cardiogenic shock by providing mechanical circulatory support. ECMO can prevent multi-organ failure and optimize organ function, leading to potential recoveries ranging from complete heart recovery to bridge-to-transplantation or durable Left Ventricular Assist Device (LVAD).
- VA-ECMO involves drainage from a femoral vein and return to a femoral artery. Though ECMO provides hemodynamic support, it also increases afterload and left ventricular wall stress, necessitating strategies for left ventricular unloading. ECMO is indicated in various scenarios including acute myocardial infarction, post-cardiotomy failure, myocarditis, and massive pulmonary embolism.
- Potential complications of VA-ECMO include bleeding, hematomas, infections, and the rare "harlequin syndrome." Monitoring parameters include maintaining a MAP above 65 mmHg, minimizing vasopressor use, and monitoring organ recovery. A multidisciplinary team approach and clear communication are essential for successful ECMO management.
Sample Certificate
About the Speakers
Dr V Rakesh
Consultant and HOD, - Critical Care and ECMO Gemcare Hospitals
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