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ECMO

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by

Femke Smit

on 9 September 2015

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Transcript of ECMO

Nursing patients on
ECLS
ECMO
PLS
ECLS
PECLA
PALP
Extra Corporeal Life Support
Permanent Life Support
Extra Corporeal Life Support
Terminologie
Doel
Indicaties en contra indicaties
Complicaties
Verzorging
CVVH
Protocollen
Troubleshooting
Casus
Toekomst
History
goal
Veno Venous
Veno arterial
“Lung rest” to prevent baro-,volu- en
stretchtrauma with or without mechanical ventillation to treat isolated lungfailure.
For patients with circulation failure without or i.c.w. respiratoiry failure.
indications
Acute and severe cardiac and/or pulmonary dysfunction with a high chance of mortality despite optimal conventional therapy.
Bridge to….
Peri CPR ( ECPR)
ECLS can extend the duration of cardiopulmonary resuscitation.

Patients need to have a revirsible illness (?)

Crit Care Med. 2008 Sep;36(9):2529-35
Contra indications
famke
Extra Corporeal Life Support
Permanent Life Support
brand name
Extra Corporeal Membrane Oxygenation
Terminologie
What is ECLS?
How does ECLS work?
What are important focus areas?
How can i improve care?
Irreversibele damage
severe comorbidity
Terminal state, malige disease(?)
massive bleeding
Aorta dissection and/or aorta insufficience
( only V-A)
Pumpless Extra Corporeal Lung Assist
Basics
checks per hour
care
Verpleegkundig Protocol
Medisch Protocol
Het circuit
Gasblender
Handcranck
Kochers
Oxygenator
Rotaflow pomp
Contactgel
Zaklamp
Rotaflow console
O2 tankje voor nood en transport
check APTT/ ACT
Lock the bed!
know the values for that patient
picking up on changes with the patient ond or the machine and feed back in time to doc or perfusionist.
Anticipate and react op changes, events and alarms of the device.
Think about end of life care.
hourly:
o RPM (rotations per minute)
o LPM (liters blood per minute)depending on rotations per minute and fluidstatus of the patient)
o Fresh Gasflow
o Fio2 on the ECLS.
o Temperature of heater
o position of canulas and system; position -kinks-pressure areas etc.
o clots in filter?!
o CVVH: check pressure on machine and connections
always notify doc/ perfusionist when you see abnormal values for that patient. always notify perfusionist in emergencies and with not-understood events!!!
Als de venous tube of ECLS is swinging and the bloodflow drops, this is a sign of...

What to do with clots in the oxygenator?

Whate to do with high CO2 in bloodgas?

Een patiënt heeft Veno Arteriele ECLS, aan de linkerhand zit de saturatie meter, deze is 99%. In het bloedgas wat is afgenomen uit de rechter radialis komt een PaO2 van 60 mmhg ( 7,9Kpa). Hoe kan dit?

You see VF (ventrikel fibrilation), what do you do?


clotting in ECLS circuit
Decanulation
Suction event
Bleeding
Tamponade
Embolism / thrombose
Pump failure
pressure ulcers
Ischeamic leg
Complications
inflow femoral cannula
mobilisation
Troubleshooting
CVVH on ECMO
Why?
How?

Fysiotherapie in early stage
attention for position of legs
less ICU weakness
less IC days
Lower mortality
less complications
future
smaler devices
more EClS op IC ( less IABP)
on site canulation
easy canulation
extubation en mobilization
indications change
expertise centra?
ECMO in UMCU
2008 eerste ECMO patiënt
totaal 111 patiënten behandeld
Organisatie en scholing

ECMO per jaar:
2008: 3 patiënten aan ECMO , allen V-A
2009: 11 patiënten aan ECMO , 2 V-V, 9 V-A
2010: 11 patiënten aan ECMO, 4 V-V, 7 V-A
2011: 15 patiënten aan ECMO, 2 V-V, 13 V-A
2012: 23 patiënten aan ECMO, 4 V-V, 13 V-A
2013: 35 patiënten aan ECMO, 4 V-V, 24 V-A
2014 : 55 patients

Total days ECLS
2008: 16 dagen
2009: 44 dagen
2010: 135 dagen
2011: 160 dagen
2012: 236 dagen
2013: 386 dagen
2014: 500 days
Nulmeting
Wat is ECMO?
Wat is het verschil tussen een steunhart en ECMO?
Waarom behandelen we met ECMO?
Transport

ECLS in the ambulance

ECLS in a plane

ECLS canulate on site
Instellingen ECMO
cannulatie
streefwaarden
weanen
antistolling
Long protectief beademen
Blijf logisch nadenken
Vertrouw op je klinische blik
Consulteer collega's met meer ervaring op dit gebied
Pak de protocollen erbij
Vragen?
Bedankt voor uw aandacht
Casus

Man 56 jaar
voorgeschiedenis -
MICU uit Ede
Daar 14 dgn buikligging
ARDS H1N1 en aspergillus pneumonie

ABG binnenkomst:
PH 7,11
PcO2 110 ( 14,6 KPA)
PO2 81 ( 10,7 KPA)
BIC 34,1
BE 2,6
sat 93

Na inbrengen ECMO:
PH 7,32
PcO2 59
PO2 84
BIC 29
BE 2,6
Sat 97


ECMO 52 dagen
2e canule in femoralis
aan/uit
snelheid LPM
flow RPM
status
batterij charging
extern voltage
batterij
RPM instellen
alarm stil
ijken
console en oxygenator
Pump Assisted Lung Protection
Full transcript