ECMO: A Practical Guide to Management

Preface
Contents
Chapter 1: History of ECMO
	Development of Extracorporeal Support
	Current State of Evidence
		VV
	ECMO for Cardiac Failure
	Current State of the ECMO Community
	References
Chapter 2: Program Development
	Creating an ECMO Program
	Program Structure and Management
		Leadership
		The ECMO Team
		The Bedside Specialist
			Table 2.2 Summary of roles and responsibilities within an ECMO program
			Table 2.3 Summary of bedside staffing models
		Consults
		Remote Cannulation
		eCPR
		Equipment and Disposables
		Documentation and Charting
	Successful Programs
	References
Chapter 3: Indications for ECMO
	Types of ECMO
	Patient Selection
	Optimization of Conventional Measures Prior to ECMO
	Justification for ECMO
	Indications/Contraindications
	Oxygenation Index
	Murray Score
	Indications as per ELSO Criteria [12]
	Indications as per CESAR Trial Criteria [13]
	Indications as per EOLIA Trial Criteria [14]
	Venovenous ECMO: Neonates [15]
	Venovenous ECMO: Pediatrics
	Venovenous ECMO: Adults
	Indications for VA-ECMO in Neonates [15]
	Indications for VA-ECMO in Pediatrics
	Indications for VA-ECMO in Adults [16]
	Indications for Central Cannulation
	VV Versus VA Versus VAV
		Advantages and Disadvantages with Hybrid Modes
	Special Groups
	Triage and Limited Resources
	Consent and Family Preparation
	COVID and ECMO
	Recommendations Specific to COVID-19
	References
Chapter 4: Physics and Technology
	Blood Flow
	Centrifugal Pumps
	Sensors and Safety Components
	EMR Integration
	References
Chapter 5: Physiology I: Venovenous ECMO
	Respiratory Physiology
		Ventilation, Diffusion, and Perfusion
		Oxygen and Carbon Dioxide Transport
		Ventilation Control
		Respiratory Mechanics
	ECMO Physiology
		ECMO Oxygen Delivery and CO2 Clearance
		Matching VO2, DO2, and ECMO
	General Management of the VV-ECMO Patient
		Respiratory Management
		ECMO Circuit and Patient Interaction
	Summary
	References
Chapter 6: Physiology II: Venoarterial ECMO
	Introduction
	Cardiac Physiology
	Variations in Cardiac Physiology
	Physiologic Goals of VA ECMO
	Indications for VA ECMO
	Initiation of VA ECMO
	Management of VA ECMO
	Anticoagulation on VA ECMO
	Left Ventricular Venting
	Oxygenation and Hypoxia on VA ECMO
	RV Support
	Combinations in Extracorporeal Support
	Hybrid and Parallel ECMO Circuits
	References
Chapter 7: ECMO Cannulation and Configuration
	Introduction
	Extracorporeal Support Cannulas
		Peripheral Versus Surgical Cannula Types
		Single-Lumen Cannula
		Double-Lumen Cannula
		Distal Perfusion Cannula (DPC)
	How to Choose Your Cannula
	ECMO Cannula Configurations
		Conventional Configurations
			VV ECMO Configurations
				Fem-Jugular VV ECMO
				Fem-Femoral VV ECMO
				Bicaval Dual-Lumen Cannulation
				Veno-Pulmonary Arterial Cannulation (VPa)
			VA ECMO Configurations
				Peripheral VA ECMO
					Fem-Femoral VA ECMO
					Fem-Subclavian or Fem-Axillary
				Central VA ECMO
		Hybrid Configurations
			Veno-Venovenous (VV-V)
			Veno-Arteriovenous Configuration (V-AV)
			Veno-Venoarterial Cannulation (VV-A)
			Veno-Venoarterial Cannulation (V-VA)
	Cannulation Technique
		Preparation
		General Steps of Cannulation [6]
		Special Consideration in Cannulation
	Complications of Cannulation
		Vascular Injury
		Leg Ischemia
		Lower Limb DVT
		Compartmental Syndrome
		Bleeding
		Infection
		Configuration Complication
			Differential Hypoxia
			Right Ventricular Rupture
	References
Chapter 8: Complications and Emergencies Associated with ECMO
	Background and Introduction
	Common Complications Associated with ECMO Support
		Bleeding
		Thrombosis
		Infection
		Chugging/Chatter
		Hypoxia
	Other Complications Associated with ECMO Support
		Neurologic Complications
		Pulmonary Complications
		Cardiovascular Complications
		Hematologic Complications
		Gastrointestinal and Hepatobiliary Complications
		Renal or Genitourinary Complications
	Emergencies and Catastrophic Events
		Air
		Accidental Decannulation
		Pump Failure
	Conclusion
	References
Chapter 9: Patient Care while on ECMO
	Objectives
	Introduction
	Basic Care Considerations
		Cannula Care and Monitoring
		Nutrition for the ECMO Patient
		Hemodynamic Monitoring
	Mobilization and Rehabilitation
		Ambulation and Cannula Positioning
	Transport of the ECMO Patient
		Intra-Hospital Transport
		Inter-Hospital Transport
	Sedation and Paralysis Considerations
		Paralysis Considerations
	References
Chapter 10: Pharmacology and Anticoagulation in ECMO
	Normal Hemostasis and ECMO
	Anticoagulation in ECMO
		Unfractionated Heparin (UFH)
		Heparin Resistance and Antithrombin (AT) Supplementation
		Heparin-Induced Thrombocytopenia
		Direct Thrombin Inhibitors
	Assessment of Bleeding
	Conclusion
	References
Chapter 11: Weaning and Decannulation
	Introduction
		Weaning of VV ECMO
		Discontinuation Procedure
		Lung Recruitment
		Tracheostomy
		Decannulation
		Discontinuation for Futility
		Failure to Wean
			Criteria for Weaning
	Predictors of Weaning
		Technique for Weaning VA ECMO
		Failure to Wean
		Post Decannulation
	Cessation of Support in Setting of End of Life Care
		Post-ECMO Follow-up (in Hospital and Post-Discharge)
	References
Index