【体外膜肺ECMO精品课件】 ECMO 在儿科中的使用.pptVIP

ECMO Introduction ECMO is frequently instituted using cervical cannulation, which can be performed under local anesthesia. ECMO is used for longer-term support ranging from 3-10 days. The purpose of ECMO is to allow time for intrinsic recovery of the lungs and heart Equipment Blood pump with raceway tubing, a venous reservoir, a membrane oxygenator, and a countercurrent heat exchanger The blood pump is either a simple roller pump or a constrained vortex centrifugal pump. The roller pump causes less hemolysis and is used for neonatal ECMO. The oxygenator is responsible for exchanging both oxygen and carbon dioxide and is central to the successful performance of prolonged ECMO.  Neonatal extracorporeal membrane oxygenation Patients with the following 2 major neonatal diagnoses require the use of extracorporeal membrane oxygenation (ECMO): Primary diagnoses associated with primary pulmonary hypertension of the newborn (PPHN), including idiopathic PPHN, meconium aspiration syndrome, respiratory distress syndrome, group B streptococcal sepsis, and asphyxia Congenital diaphragmatic hernia (CDH) Selection criteria for neonates Gestational age of 34 weeks or more Birth weight of 2000 g or higher No significant coagulopathy or uncontrolled bleeding No major intracranial hemorrhage (grade 1 intracranial hemorrhage) Mechanical ventilation for 10-14 days or less Reversible lung injury No lethal malformations No major untreatable cardiac malformation Failure of maximal medical therapy Failure to meet these criteria is a relative contraindication for ECMO Qualifying patient criteria for ECMO Qualifying criteria are applied only when the infant has reached maximal ventilatory support of 100% oxygen with peak inspiratory pressures (PIP) often as high as 35 cm H2 O. Alveolar-arterial (A-a) gradient of 600-624 mm Hg for 4-12 hours at sea level, which may be computed as follows (where 47=partial pressure of water vapor): (A-a)(Diffusing capacity [D] of O2 equals atmospher