Traumacast ECMO: Overview for the Acute Care Surgeon and Current Techniques and Indications
Feb 21, 2017
Dr. Jay Menaker, the Medical Director of the Lung Rescue Unit, discusses the evolution of ECMO in acute care surgery. He highlights its role in rescuing patients with severe respiratory failure and the impact of the H1N1 epidemic on its development. The conversation covers the importance of patient selection using the Murray score, the protocols for trauma patients, and potential complications like bleeding. Menaker also emphasizes the necessity of hands-on experience and ongoing education for healthcare professionals to master ECMO techniques.
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VV ECMO Basics Explained
- VV ECMO acts as an external lung dialysis, oxygenating blood and removing CO2 while bypassing lung function.
- Blood is typically taken from a femoral vein and returned via the right internal jugular vein into the right atrium.
VA ECMO Physiology and Use
- VA ECMO removes blood from a vein but returns it to an artery, providing both cardiac and respiratory support.
- Retrograde arterial flow from VA ECMO mixes with native cardiac output, requiring careful monitoring.
Call ECMO Early for ARDS
- Consider ECMO for trauma patients with severe respiratory failure at high ventilation settings like APRV P1 of 30 and FIO2 around 60%.
- Early consultation and ECMO consideration is better than late emergent use.