ECMO Essentials with Dr. Karen Fauman & the Cribsiders--Part 1
Mar 1, 2023
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Dr. Karen Fauman, an Associate Professor of Pediatrics and ECMO enthusiast, discusses ECMO essentials with the Cribsiders in this podcast. They cover topics such as the basic pathophysiology of oxygen delivery, indications for VV and VA ECMO, the sequence of the ECMO circuit, and signs that a patient may be ready to be liberated from ECMO.
VV ECMO is used for respiratory failure, while VA ECMO is used for cardiac or hemodynamic failure.
Ideal ECMO candidates have a reversible condition, need to be carefully assessed, and should allow the patient's lungs to rest and recover during VV ECMO use.
Deep dives
VV ECMO for respiratory failure patients
VV ECMO is commonly used for patients with respiratory failure, such as severe ARDS, pneumonia, or influenza, when optimal mechanical ventilation and other treatments have failed to adequately oxygenate the blood. It involves draining blood from the patient through a large catheter, exchanging oxygen and removing carbon dioxide in the membrane oxygenator, and then returning the oxygenated blood back to the patient's venous system through an appropriate cannula.
VA ECMO for patients with cardiac and hemodynamic failure
VA ECMO is typically used for patients with cardiac or hemodynamic failure, including myocarditis, congenital heart disease, septic shock, and toxic ingestions. It provides both cardiac and respiratory support by draining blood from the patient through a large cannula, oxygenating it in the membrane oxygenator, and then returning it back to the patient through an arterial cannula. VA ECMO can maintain systemic perfusion and blood flow in patients with compromised cardiac function.
General indications for ECMO candidacy
Ideal ECMO candidates have a reversible condition with no underlying major medical conditions, intact immune system, available cannulation sites, and an expected course of less than a few weeks. They should be assessed for their likelihood of successful recovery, taking into consideration the specific indications for VV or VA ECMO and the potential risks and benefits of treatment. Infants under a certain weight or gestational age may have limitations in ECMO candidacy, and decisions about ECMO use should be made carefully, considering the scarcity of this resource and the potential outcomes for the patient.
Resting the lungs and cautious weaning from ECMO
When using VV ECMO, it is important to allow the patient's lungs to rest and recover. The focus should be on maintaining low ventilator settings and avoiding aggressive attempts to wean the patient from ECMO too early. Resting the lungs allows for possible recovery of pulmonary compliance and function. Gradual testing can be done to assess if the lungs are responding positively before considering a further decrease in ECMO support. Patience and careful monitoring are essential in the weaning process to maximize the chances of successful ECMO withdrawal.
Karen Fauman, MD is an Associate Professor of Pediatrics at the University of Chicago and dual boarded pediatric intensivist and palliative care physician at Comer Children’s. She received her medical degree, pediatric and pediatric critical care training at the University of Michigan. Now at the University of Chicago she serves as the critical care medicine fellowship program director and the ECMO medical director. She is very active in ECMO-related research with an added focus on the psychosocial aspects of critical care in children.
The Cribsiders is a pediatric medicine podcast composed of a national network of students, residents and clinician educators from across the country and multiple institutions. On the show we “curbside” the experts to deconstruct various topics in the world of medicine to provide listeners with clinical pearls, practice-changing knowledge and a weight-based dosing of fun.
Learning Objectives:
After listening to this episode listeners will…
Recall the basic pathophysiology of oxygen delivery
Identify the different indications for VV and VA ECMO
Be familiar with the basic sequence of the ECMO circuit
Recognize ECMO settings and how changing these will impact oxygenation and ventilation
Be familiar with signs that a patient may be ready to be liberated from ECMO
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedsc
How to support PedsCrit: Please complete our Listener Feedback Survey Please rate and review on Spotify and Apple Podcasts! Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.
Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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