SHA24/003003

CASE STUDY ECMO / ECLS EXTRACORPOREAL MEMBRANE OXYGENATION EXTRACORPOREAL LIFE SUPPORT

ISMAEL SULIMAN AL ENEZI KAMC (KFNGH), CVP, CPP, ODP, NVQ, WBA, ATSHI,

HISTORY •

THE PATIENT: 14 years old girl 67 kg

•

Pneumonia cough and chest pain

•

ER

•

Desaturation

•

Arrest

•

Intubated

•

ARDS

•

High Co2 low sat

•

ECMO

CALL ECMO TEAM DISCUSSION DECISION

• Initiation • Setup – adult ecmo set maquet • Oxygenator quadroux Maquet • Pumb rotafolw • Cannulation • Arterial - internal jugular vien to SVC size 17 Fr medtroinc cannulae • Veinous Femoral vien to IVC 21 Fr medtronic cannulae

INITIATION

• Crystalloid • Debubble • Add druges • Blood • Take a ABG

INITIATION

INITIATION

MAINTENANCE •

Blood flow ( 4.7 – 5.0 )

•

Diuresis and fluid balance ( hemofiltration ) diuretics

•

Sampling ABG and VBG

•

Temperature ( 36 )

•

Gas flow and Fio2 ( 100% and 5l/min)

COMPLICATIONS •

Bleeding • Nose • Mouthe • Cannulations sites

• ACT 170 – 200 • Awake patient

COMPLICATIONS •

Low Hb ( 11 – 13 )

•

Hematuria

•

Urine output

COMPLICATIONS

•

Hematuria

•

Urine output

COMPLICATIONS

• Low flow and chattering

WEANING AND DISCONTINUING

•

Chest X-rays

WEANING AND DISCONTINUING •

Chest X-rays

•

Ventilatore • Tidale volume • PEEP

• Platio • Co2 • SAT

WEANING AND DISCONTINUING •

Lower the fi02

•

Lower the sweep

•

Till complete stop of gas

•

Maintain normal flow

•

ABG every 15min - first hour –

•

Patient take over

•

Stop and decannulate

Patient is in the ward now

Thank you