ECMO Principles and Practice

Introduction

  • Mike Toria, a new faculty member at ITICU, also works with Chanel at Harborview for the ECMO program and is involved in transport work with Airlift.
  • Trained at the University of New Mexico.
  • The ECMO and ECPR programs are robust, with approximately 150 ECPR cases in recent years.
  • The presentation is designed to be straightforward with more pictures and conceptual stuff, consistent with core materials available online.
  • The cardiac lecture, the prior lecture, and this lecture are the foundation of understanding ECMO.

Fundamentals and Decision-Making

  • Understanding the fundamentals of physiology explains 90% of decisions in ECMO.
  • Simplifying complex scenarios to fundamental elements is crucial for expanding knowledge.
  • The field of ECMO is rapidly changing. Guidelines and practices evolve quickly, sometimes even in a matter of months.
  • Core ECMO is a valuable resource for review and learning, even for experienced practitioners.

VA vs. VV ECMO

  • Separating VA (Veno-Arterial) from VV (Veno-Venous) ECMO is essential due to differences in pathology and physiology.

VA ECMO

  • VA ECMO involves draining blood from a vein and returning it to an artery.
  • The system may involve additional plumbing and devices, such as TandemLife and offloading devices.
  • Blue labels typically indicate drainage from the vein, while red labels indicate return to the artery.
  • Identifying the drainage and return points is fundamental for understanding the system. The distal reperfusion cannula is also on the return side.