ECMO介绍—台大医院.pptVIP

ECMO Introduction 台大醫院 外科加護病房 柯文哲 醫師 ECMO Introduction Dr. Wen-Je Ko SICU, Department of Surgery National Taiwan University Hospital ECMO extracorporeal membrane oxygenation (體外膜氧合器) (艾克膜) (體外維生系統) ECMO extracorporeal membrane oxygenation (Extracorporeal Life Support) ECMO ??prolonged partial cardiopulmonary bypass ECMO vs CPB Veneous reservoir CPB vs ECMO ECMO Short-term cardiopulmonary support Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,..) Give-up for lung 1. support : O2 supply CO2 removal 2. rest : reduce ventilator induced lung injury for heart support : improve systemic perfusion rest : ↓catecholamine ↓myocardial work decrease preload requirement and congestion ECMO Type VV - ECMO VA - ECMO VV-ECMO indication : for lung disease only purpose : to decrease barotrauma ( to prevent ventilator-induced lung injury) ventilator setting : PC mode, PEEP 10 , PIP 35 , VR -- PaCO2, FiO2-- PaO2 VA-ECMO advantage : 1. both lung heart support 2. higher PaO2 An Example of MCS Different patients Different situations ? Different treatments Indications of ECMO in the near future As a mechanical circulatory support: Post-cardiotomy cardiogenic shock Double bridge (ECMO? VAD? HTx) Acute myocarditis AMI cardiogenic shock (ECPR) Replace CPB: Lung transplantation Neurosurgery Non-heart-beating-donor support Rescue for acute pulmonary embolism Ventilatory support ARDS Neonatal pulmonary diseases ECMO VAD HTx * *