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