Extracorporeal Membrane Oxygenation

Therapy (ECMO)

Mary Ann Degges, DNP, RN, CNL, CCNS

Advanced Nursing Coordinator

Cardiovascular Services

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ECMO

AKA extracorporeal life support (ECLS)

Venoarterial (VA) support

Venovenous (VV) support

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ECMO

Achieved by draining

venous blood,

removing carbon

dioxide and adding

oxygen through an

artificial lung, and

returning the blood to

the circulation via

either the venous or

arterial circulation.

http://www.youtube.co

m/watch?v=XWTOBZy

eoQw

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ECMO

VA ECMO VV ECMO

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ECMO

Central Cannulation

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ECMO

Indications for adults:

Adult respiratory failure

Influenza

Carbon monoxide poisoning

Cystic fibrosis (bridge-to-transplant)

Sepsis

Cardiac failure

Cardiogenic shock

Bridge to VAD or transplant

Inability to wean from cardiopulmonary bypass

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ECMO-Nursing Considerations

Usual ICU care

Cannula securement and insertion site

Limb monitoring

Anticoagulation

Sedation and pain management

ECMO specialist

Patient and family centered care

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ECMO Case 1

Carbon monoxide

poisoning

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ECMO Case 1

38 year old critically ill with multisystem organ

failure due to carbon monoxide poisoning

Placed on VA ECMO for 5 days

Woke up after 9 days and was neurologically

appropriate

Weaned from ECMO and eventually

discharged to home

http://www.newschannel5.com/story/24088405/holiday-miracle-

for-mid-state-family

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ECMO Case 1

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ECMO Case 2

24 year old female admitted with acute onset of

hypoxia, tachycardia and hypotension

Oxygen saturation 80% at OSH requiring

urgent intubation

Oxygen saturation on 100% with PEEP of 5 cm

was in the 70s during transfer to UABH

Questionable pneumonia versus pulmonary

edema secondary to heart failure

34 weeks gestation

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ECMO Case 2

Bedside ECHO revealed LVEF of 15-20%

Unresponsive to conventional medical therapy

Unable to obtain fetal heart tones-fetal demise

Placed on VA ECMO

Etiology unclear:

Sepsis/ARDS

Peripartum cardiomyopathy

PTE

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ECMO Case 2

On day after admission, patient went into labor

and baby was delivered

Right after delivery ST segment changes were

noted in anterolateral leads of ECG

Taken to cath lab-coronary arteries were clean

ECMO flow decreased and IABP placed

LVEF steadily improved and ECMO

decannulation occurred on day 5

Residual RV dysfunction with PHTN

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ECMO Case 3

25 year old female transferred from OSH with

pneumonia and respiratory distress

24 weeks gestation-fetal tones heard

Upon arrival to OB service at UABH, oxygen

saturation 88-90% with RR 50s

MET activated-intubated and sedated

Tested + for mycoplasma pneumonia at OSH

Sepsis and ARDS

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ECMO Case 3

Transferred to MICU service but not

responsive to conventional therapies

Placed on VV ECMO a few days before

Christmas and was decannulated on Christmas

Day

Her condition continued to improve and she

was discharged to home in early January

Followed by OB/GYN throughout

hospitalization

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ECMO Case 3

Follow-Up Visit After Hospital Discharge

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Watts battles H1N1 at UAB

Andalusia Star News

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Thank You!