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Extracorporeal Membrane Oxygenation (ECMO), An Issue of Critical Care Clinics, E-Book

Extracorporeal Membrane Oxygenation (ECMO), An Issue of Critical Care Clinics, E-Book

Nitin Puri | Michael Baram | Nicholas Cavarocchi

(2017)

Additional Information

Abstract

This issue of Critical Care Clinics focuses on Mechanical Circulatory Support. Editors Nitin Puri and Michael Baram have assembled an expert team of authors on topics such as: History of ECMO; Evolution current technique and equipment; Program Development; Review ELSO standards; Cardiac Failure of medical management; Cardiac Management and Complications; Pre-Respiratory; Respiratory Management and Complications; Post ECMO management; Post ECMO complication; DVT; Transport- Interhospital and How to prep patient; ECHO; Family understanding of ECMO (to cannulate or not); Pharmacy, Nutrition, Blood Management; Transport; The future of ECMO and ventilation.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Extracorporeal Membrane Oxygenation\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Preface: Extracorporeal Membrane Oxygenation vii
Introduction to Extracorporeal Membrane Oxygenation vii
Developing an Extracorporeal Membrane Oxygenation Program vii
Cardiac Support: Emphasis on Venoarterial ECMO vii
Management Strategies for Severe Respiratory Failure: As Extracorporeal Membrane Oxygenation Is Being Considered vii
Vascular Complications in Extracorporeal Membrane Oxygenation viii
Pediatric Extracorporeal Membrane Oxygenation viii
Extracorporeal Membrane Oxygenation Management: Techniques to Liberate from Extracorporeal Membrane Oxygenation and Manage ... viii
Issues in the Intensive Care Unit for Patients with Extracorporeal Membrane Oxygenation ix
Staffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation ix
Transport While on Extracorporeal Membrane Oxygenation Support ix
Medication Complications in Extracorporeal Membrane Oxygenation ix
CRITICAL CARE CLINICS\r \r x
FORTHCOMING ISSUES x
January 2018 x
April 2018 x
RECENT ISSUES x
July 2017 x
April 2017 x
January 2017 x
Preface:\rExtracorporeal Membrane Oxygenation xi
Introduction to Extracorporeal Membrane Oxygenation 763
Key points 763
INTRODUCTION 763
HISTORY 764
PROGRAM EVOLUTION 764
ISSUE STRUCTURE 765
SUMMARY 766
REFERENCES 766
Developing an Extracorporeal Membrane Oxygenation Program 767
Key points 767
INTRODUCTION 767
INSTITUTIONAL COMMITMENT 768
Market Analysis 768
Needs Assessment 768
Program Vision 768
Outreach and Inreach 769
Financial Assessment and Business Plan 769
TECHNOLOGY AND EQUIPMENT 769
Pumps 770
Heater/Cooler 770
Monitors 770
Blood Analyzers 770
Disposables 771
Membrane Oxygenators 771
Cannula 771
Facility Planning 771
TEAM BUILDING/STAFF MODELS 772
Guidelines for Training and Continuous Education of Extracorporeal Membrane Oxygenation Specialists 772
Initial training 772
Continuing education 773
Policies and Protocols 773
Program Evaluation 774
REFERENCES 774
Cardiac Support 777
Key points 777
INTRODUCTION 777
WHAT IS VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION AND HOW DOES IT DIFFER FROM VENOVENOUS EXTRACORPOREAL MEMBRANE OXY ... 778
HOW TO SELECT APPROPRIATE PATIENTS FOR VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION. WHAT ARE THE INDICATIONS AND CONTR ... 779
General Considerations 779
Indications for Venoarterial Extracorporeal Membrane Oxygenation 780
Refractory Cardiogenic Shock 780
Extracorporeal Cardiopulmonary Resuscitation 781
Massive Pulmonary Embolism 782
Accidental Hypothermia 782
Septic Shock 782
Pulmonary Hypertension 783
Additional Indications 783
Contraindications to Venoarterial Extracorporeal Membrane Oxygenation 783
THE DECISION HAS BEEN MADE TO PROCEED WITH EXTRACORPOREAL MEMBRANE OXYGENATION. HOW IS THE OPTIMAL CANNULATION STRATEGY DET ... 783
Central Cannulation 783
Peripheral Cannulation 784
Venous (Inflow) Cannula 784
Arterial (Outflow) Cannula 784
TRIPLE CANNULATION STRATEGIES 785
Venoarteriovenous Extracorporeal Membrane Oxygenation 785
Venovenoarterial Extracorporeal Membrane Oxygenation 786
Additional Therapies 787
How to Manage Patients Who Are Cannulated and on Extracorporeal Membrane Oxygenation Support 787
HEMODYNAMIC SUPPORT 788
Determine the Degree of Support Required 788
Optimize Flow 788
Optimize Mean Arterial Pressure 788
Maintain Pulsatility 788
Ensure Adequate Gas Exchange 789
Extracorporeal Membrane Oxygenation Circuit 789
Ventilator Management 789
Monitoring Adequacy of Perfusion 790
Hemoglobin Concentration 790
Anticoagulation and Bleeding 791
SUMMARY 791
REFERENCES 791
Management Strategies for Severe Respiratory Failure 795
Key points 795
INTRODUCTION 795
INDICATIONS FOR EXTRACORPOREAL MEMBRANE OXYGENATION 797
Acute Respiratory Distress Syndrome 797
Lung Transplantation 798
Miscellaneous 798
APPROACH TO THE VENTILATOR PRE–EXTRACORPOREAL MEMBRANE OXYGENATION 798
Lung-Protective Strategy 798
Airway Pressure Release Ventilation and High-Frequency Oscillatory Ventilation 799
Medical Supportive Therapies 799
Corticosteroids 799
Diuretics 800
Prone-positioning 800
Vasodilators 801
Neuromuscular blockade 801
PLANNING FOR EXTRACORPOREAL MEMBRANE OXYGENATION 802
Assessment of Cardiac Function 802
Assessment for Sepsis 803
Assessment for an Inferior Vena Cava Filter 803
Assessment for Central Nervous System Disease 803
Clarification of Goals of Care 803
SUMMARY 804
REFERENCES 804
Vascular Complications in Extracoporeal Membrane Oxygenation 813
Key points 813
INTRODUCTION 813
PATIENT EVALUATION 814
Vascular Access for Venoarterial Extracorporeal Membrane Oxygenation 814
Cannula Size Selection 814
Vascular Access for Venovenous Extracorporeal Membrane Oxygenation 815
VASCULAR COMPLICATIONS 817
Thromboembolic Complications 817
Clinical manifestations 817
Treatment of ischemic complications 817
Vessel Damage 820
Clinical manifestations 820
Prevention and treatment 820
Infection 821
Clinical manifestations 821
Prevention and treatment of infection 821
SUMMARY 821
REFERENCES 822
Pediatric Extracorporeal Membrane Oxygenation 825
Key points 825
INTRODUCTION 825
EQUIPMENT AND EXTRACORPOREAL MODES 826
Circuit 826
Roller Pumps 826
Centrifugal Pumps 827
Pressure and Flow Monitors 828
Membrane Lungs 828
Modes of Support: Venovenous Support 829
Modes of Support: Venoarterial Support 830
Patient Care 832
INDICATIONS AND CONTRAINDICATIONS 832
VENTILATOR MANAGEMENT 833
PHARMACOLOGY 833
Sedation and Analgesia 833
ANTICOAGULATION MANAGEMENT 834
Anticoagulation 834
Antithrombin III 834
FLUID OVERLOAD AND RENAL DYSFUNCTION 834
WEANING FROM EXTRACORPOREAL SUPPORT 835
NUTRITION 835
HEMOLYSIS AND PLASMAPHERESIS 836
COMPLICATIONS (EXCERPTED FROM THE PEDIATRIC AND NEONATAL PORTION OF THE INTERNATIONAL EXTRACORPOREAL LIFE SUPPORT ORGANIZAT ... 836
Bleeding 836
Cannula site bleeding 836
Surgical site bleeding 837
Gastrointestinal hemorrhage 837
Cardiac tamponade 837
Central nervous system complications 837
Infection 838
Mechanical Complications 838
Premature de-cannulation 838
Membrane lung failure 838
Tubing rupture 838
Pump malfunction 839
OUTCOMES 839
REFERENCES 839
Extracorporeal Membrane Oxygenation Management 843
Key points 843
INTRODUCTION 843
COMPLICATIONS 844
WEANING FROM EXTRACORPOREAL MEMBRANE OXYGENATION 844
Weaning from venovenous–extracorporeal membrane oxygenation 845
Weaning from venoarterial–extracorporeal membrane oxygenation 845
Venoarterial Extracorporeal Membrane Oxygenation Weaning for Cardiogenic Shock 846
POST–EXTRACORPOREAL MEMBRANE OXYGENATION MANAGEMENT 849
Systemic Inflammatory Response Syndrome 849
Post–Extracorporeal Membrane Oxygenation Complications 849
Delirium 849
Posttraumatic Stress Disorder 850
Rehabilitation 851
End-of-Life Issues 851
SUMMARY 851
REFERENCES 851
Issues in the Intensive Care Unit for Patients with Extracorporeal Membrane Oxygenation 855
Key points 855
INTRODUCTION 855
CARDIAC CIRCULATION 856
PULMONARY 857
METABOLIC 858
GASTROINTESTINAL 858
VASCULAR 858
HEMATOLOGY 858
INFECTION 859
NEUROLOGIC 859
INPATIENT TRANSPORT 860
FAMILY INVOLVEMENT 860
REFERENCES 860
Staffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation 863
Key points 863
INTRODUCTION 863
Educational Models for Extracorporeal Membrane Oxygenation Specialists 864
Staffing models for extracorporeal membrane oxygenation patients 866
EXTRACORPOREAL MEMBRANE OXYGENATION EQUIPMENT 867
Extracorporeal Membrane Oxygenation Centrifugal Pumps and Pump Consoles 867
Maquet RotaFlow 867
Thoratec CentriMag 869
Maquet CardioHelp 870
Extracorporeal Membrane Oxygenation Oxygenators 871
Extracorporeal Membrane Oxygenation Cannula 871
Dual-Lumen Venovenous Cannula 872
Femoral/Peripheral Cannulas 873
Central Cannulation 874
MONITORING DEVICES FOR EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT 874
Ultrasonic Flow Probes 874
Extracorporeal Membrane Oxygenation Circuit Pressure Monitoring 874
Oxygen Analyzers, Inline Blood Gas Monitoring, and Temperature Monitoring 875
Near-Infrared Spectroscopy 876
The Future: Remote Monitoring and Telemedicine 879
REFERENCES 879
Transport While on Extracorporeal Membrane Oxygenation Support 883
Key points 883
INTRODUCTION 883
EVOLUTION OF TRANSPORT WHILE ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT 885
TRANSPORT LOGISTICS WHILE ON EXTRACORPOREAL MEMBRANE OXYGENATION SUPPORT 885
MISSION PLANNING 887
MODE OF TRANSPORT 887
EQUIPMENT 888
TEAM COMPOSITION 889
FLIGHT CONSIDERATIONS 889
Atmospheric Pressure 889
Oxygenation 890
Temperature 890
Noise and Vibration 890
Acceleration and Deceleration Forces 890
Humidity 891
Vision 891
ADVERSE EVENTS 891
SUMMARY 892
REFERENCES 894
Medication Complications in Extracorporeal Membrane Oxygenation 897
Key points 897
INTRODUCTION 897
EXTRACORPOREAL MEMBRANE OXYGENATION AND PHARMACOKINETICS 898
Drug Sequestration 899
Volume of Distribution 899
SEDATIVES/ANALGESICS-OPIOIDS 901
Fentanyl 901
Other Opioids 907
Ketamine 907
Benzodiazepines 907
Propofol and Dexmedetomidine 908
NEUROMUSCULAR BLOCKADE 908
ANTICOAGULATION 908
ANTIBIOTICS 910
Vancomycin 910
Carbapenems 911
Piperacillin/Tazobactam 911
Aminoglycosides 912
Azithromycin 912
Linezolid 912
Tigecycline 913
Oseltamivir 913
Ribavirin 913
ANTIFUNGALS 913
Amphotericin B 913
Echinocandins/Azoles 914
Antituberculosis Agents 914
SUMMARY 915
REFERENCES 915