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ECMO FUNDAMENTALS by Nick Mark MD & Jonah Rubin MD ONE
Link to the
@nickmmark most current
PURPOSE & DEFINITIONS: INDICATIONS: @JonahRubinMD version →
· ExtraCorporeal Membrane Oxygenation (ECMO) provides · VV: Refractory hypoxemia/mixed respiratory failure used
as a bridge to recovery or transplant ABG Pulse Ox
prolonged pulmonary and/or circulatory support by removing
venous blood, pumping it across an artificial lung (oxygenator · ECCO2R: Refractory hypercapnia similar to VV but with
lower flow/smaller sized cannula
pH PCO2 PaO2 / HCO3
/ / SpO2
or membrane lung) for gas exchange, & returning it to the pt..
· VV ECMO: artificially oxygenated Venous blood is returned to · VA: Pulmonary & Circulatory support (VA) – cardiac arrest,
the Venous side (right atrium), providing no circulatory overdose, massive PE, cardiogenic shock, etc. Used as a VENTILATION OXYGENATION
support, & adding the artificial lung in series with the native bridge to recovery, transplant, or destination device. To decrease PCO2 or To increase PaO2, increase
lung. increase pH ! increase the RPM / PUMP FLOW RATE or
· VA ECMO: artificially oxygenated Venous blood is returned to SWEEP / GAS FLOW FDO2
the Arterial side (aorta), providing circulatory support, and
adding & artificial lung in parallel with the native lung.
RETURN FDO2
CANNULA
IN R IJ VEIN FDO2 (fractional delivered O2) & AIR & O2
SETTINGS/MANAGEMENT: Different DRAINAGE & RETURN BLOOD FLOW RATE determines BLENDER
· Cannula size/positioning configurations are possible. oxygenation. Initially usually set Flow
(lpm)
· Pump speed (RPM, flow) Choice depends on mode (VV vs at 100% and decreased if PaO2 is 60

· Sweep / Gas flow VA), flow requirements, & patient above goal. SWEEP GAS FLOW 55

· FDO2 determines CO2 removal.

50

anatomy. The configuration here 45

· Alarm settings
is VV ECMO. (R femoral vein 40 FiO2 (%)

· Anticoagulation strategy BUBBLE 35

· Transfusion/fluid goals drainage and R IJ vein return) DETECTOR 30

40 60

· Ventilator settings DRAINAGE SWEEP 21 100

100

CANNULA
(to minimize VILI & prevent atelectasis) IN R FEMORAL VEIN GAS FLOW

ULTRASONIC BUBBLE
CO2 O2 O2
DETECTOR is an SINLETO2 SENSOR
Oxygen saturation of blood OXYGENATOR performs gas
important safety
device that detects entering the circuit exchange (oxygenation, CO2 Air
removal) and regulates blood SOUTLETO2 HEPA
air bubbles in the
FILTER
circuit temperature with a HEAT SENSOR
EXCHANGER. This can be used PPOST-MEMBRANE (also called
PVENOUS for TTM or and it can mask a PARTERIAL) is the positive pressure
Pressure transducer returning to the patient. This is
is the negative suctioning fever.
ports can also be used lower than Ppre-membrane
to sample blood pressure applied to extract
because of resistance in the
blood via the drainage cannula OXYGENATOR OXYGENATOR.
(MEMBRANE LUNG)
The CENTRIFUGAL PUMP
moves blood through the
𝑻𝑴𝑷 = 𝑷𝑷𝒐𝒔𝒕 − 𝑷𝒑𝒓𝒆
ECMO circuit. PUMP RPM
PPRE-MEMBRANE TRANSMEMBRANE PRESSURE (𝞓P
(also called PINTERNAL) is THERMOMETER &
determines the BLOOD or TMP) is the pressure difference
v1.0 (2021-11-13)

PUMP the positive pressure HEAT EXCHANGER

FLOW RATE. Along with across the OXYGENATOR.
propelling blood
CC BY-SA 3.0

FDO2, blood flow determines RPM Trending changes in TPM may

through the oxygenator
PaO2. In VA, the pump RPMs 37 reflect the function of the
also determines CO & MAP oxygenator (e.g. clot burden).