ECMO in the Adult Patient 1st Edition by Alain Vuylsteke, Daniel Brodie, Alain Combes, Jo anne Fowles, Giles Peek ISBN 9781107681248 1107681243

Chapter 1 A brief history of ECMO

Starting point

In the beginning

Moving forward

Key points

To learn more

Chapter 2 An ECMO service

Staffing

Doctors

ECMO specialist

ECMO coordinator

ECMO director

Perfusionist

Transfer team

Other members of the team

Infrastructure

Organization

Key points

To learn more

Chapter 3 The ECMO circuit

Components of the ECMO circuit (except the cannula)

Tubing

Blood pump

Oxygenator

Heat exchangers

Circuit monitoring

Pressure monitoring

Blood gas monitoring

Flow rate

‘Human touch’ or clinical inspection

ECMO circuit selection

ECMO circuit maintenance

Key points

To learn more

Chapter 4 Monitoring the patient on ECMO

General principles

Monitoring the patient on veno-venous ECMO

Monitoring the patient on veno-arterial ECMO

Key points

To learn more

Chapter 5 Case selection

Introduction

Respiratory diseases

Reversibility

Specific considerations

Frailty

Obesity

Brain injury

Duration of ventilation

Failure of conventional management

Irreversibility and lung transplantation

Cardiac diseases

Reversibility

Specifics considerations

ECMO-assisted cardiopulmonary resuscitation

Intractable arrhythmias

Acute mechanical defect

Bridge to heart transplantation or mechanical assist devices

Unable to wean from cardiopulmonary bypass

Pulmonary embolism

Other problems requiring cardiopulmonary support

Bridge to organ donation

Other indications

Accidental hypothermia

Drug intoxication

Miscellaneous

When not to use ECMO

ECMO prediction scores

Key points

To learn more

Chapter 6 Cannulation and decannulation

Introduction

Who should insert the cannula?

Where should cannulation take place?

Cannula choice

Main features of a cannula

Materials

Surface coating

Length

Shape

Side holes

Double lumen

Additional features (insertion/side arms)

Cannula comparisons

Selection of the cannula

Cannulas for central veno-arterial ECMO

Cannulas for peripheral veno-arterial ECMO

Cannulas for veno-venous ECMO

Cannulation technique

Reperfusion cannulas

Cannula and circuit configuration

Complications of cannulation

Removal of ECMO cannulas

Removal of a venous cannula

Removal of an arterial cannula

Care after removal of a cannula

Key points

To learn more

Chapter 7 Coagulation, blood and ECMO

Haematology input

General considerations

The need for anticoagulation

Assays and blood samples

Choice of anticoagulant

Unfractionated heparin

Fractionated heparin and pentasaccharides

Direct thrombin inhibitors

Monitoring of anticoagulation

Heparin monitoring

Activated coagulation time

Activated prothrombin time

Anti-Xa levels

Thromboelastography

How important are all these tests?

Blood product transfusion

Abnormalities of blood count

Thrombocytopenia

Heparin-induced thrombocytopenia

Other causes of thrombocytopenia

Other changes in the blood film

Haemolysis

Haemoglobinopathy patients

Bleeding in patients on ECMO

Key points

To learn more

Chapter 8 Management of the patient on veno-venous ECMO: general principles

Introduction

Stabilization on veno-venous ECMO

Oxygenation during veno-venous ECMO

Mechanical ventilation in patients during veno-venous ECMO

Tidal volume and peak inspiratory pressure

Positive end-expiratory pressure

Mode of ventilation

Adjuncts to mechanical ventilation

Fluid balance

Tracheostomy

Prone positioning

Inhaled nitric oxide

Key points

To learn more

Chapter 9 Management of the patient on veno-arterial ECMO: general principles

Introduction

Stabilization on veno-arterial ECMO

Oxygenation during veno-arterial ECMO

Adjuncts to veno-arterial ECMO

Leg reperfusion

Fluid balance

Tracheostomy

Inotropes

Intra-aortic balloon pump

Ventricular vents

Key points

To learn more

Chapter 10 Patient transfer

Planning

Transfer team

Transfer equipment

Care during transfer

Transfer by air

Key points

To learn more

Chapter 11 Liberation from ECMO

Introduction

Liberating the patient on veno-venous ECMO

Liberating the patient on veno-arterial ECMO

End-of-life care

Key points

To learn more

Chapter 12 Specifics of intensive care management for the patient on ECMO

Sedation and paralysis

Ventilation and haemodynamic support during ECMO

Renal function and ECMO

Impact of ECMO on renal function

Indications for RRT in patients treated with ECMO

Methods of RRT during ECMO support

Anticoagulation with RRT and ECMO

Plasmapheresis

Sepsis on ECMO

ECMO during refractory septic shock

Nosocomial infections in patients supported with ECMO

Antibiotic therapy

Pharmacology and ECMO

Drug availability changes during ECMO

A few specific drugs and ECMO

Nutrition during ECMO

Metabolism and energy requirements for patients on ECMO

Nutrition initiation time and mode of delivery for ECMO patients

Protein, carbohydrate and lipid requirements for ECMO patients

Enteral nutrition-related complications

Nursing on ECMO

Physiotherapy on ECMO

Rehabilitation

Key points

To learn more

Chapter 13 Extracorporeal carbon dioxide removal or ECCO2R

Principles

Devices used for ECCO2R

Arterio-venous ECCO2R

Veno-venous ECCO2R

Complications of ECCO2R

Clinical management

Anticoagulation

Circuit monitoring

Patient management

Liberation from ECCO2R

Key points

To learn more

Chapter 14 ECMO to support organ donation

ECMO as a bridge for organ donation in brain-dead donors

ECMO as a bridge for organ donation in non-heart-beating donors

To learn more

Chapter 15 ECMO registries and research

The Extracorporeal Life Support Organization registry

International ECMO Network

To learn more

Appendix: The future of ECMO

Index