PerfWeb 24 Concepts in ECMO Part 3 Extracorporeal Membrane Oxygenation ECMO Circuit Design, Staffing

May 21, 2019 | ECMO, Heart Surgery

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ECMO Circuit Design and Safety

ECMO The tools to deliver

ECMO Staffing

7:00 Why oxygenator fails? (PNP fiber polypropylene fiber oxygenators)
9:23 According to ELSO, they are about 9500 ECMOs performed annually worldwide, and there are about 360 ECMO centers worldwide.
9:45 Where ECMO can be placed?
12:38 General definition of ECMO
– Venous blood drain by kinetic assistance through a pump and into an oxygenator
– Blood volumes cannot be manipulated by ECMO circuit because is no venous reservoir
13:55 ECMO circuit:
Femoral vein
Centrifugal pump
Oxygenator
Femoral artery
16:16 CCRT incorporated into ECMO circuit: (access line, CCRT, Polymixin BHP, return line)
18:10 ELSO guidelines for training and consulting education of ECMO specialists
Introduction: The term ECMO specialist is defined for the purpose of this guidelines as “the patient on ECMO under the direction and supervision of a licenced ECMO trained physician. The individual functioning as the ECMO Specialist should have a strong critical care background in neonatal, pediatric and / or adult critical care and have attained one of the following:
1. Successful of approved school of nursing and achievement of a passing score on the state written exam given by Board of Nursing for that state
2. Successful completion of an accredited school of respiratory therapy and have successfully completed the registry examination for advanced level practitioners and be recognized as Registered Respiratory Therapist (RRT) by the National Board of Respiratory Care (NBRC)
3. Successful completion of an accredited school of perfusion and national certification through the American Board of Cardiovascular Perfusion (ABCP)
4. Physicians trained in ECMO who have successfully completed institutional training requirements for the clinical specialist
5. Other medical personnel such as biomedical engineers or technician who received specific ECMO training and have practiced as an ECMO specialist since the initiation of their programs, and who have completed equivalent training in ECMO management as the other specialist , have successfully documented necessary skills as an ECMO specialist by the medical doctor. This personnel can be approved institutionally as an ECMO specialist under “grandfather” principle. However ELSO does not encourage or support new training of individuals except as outlined in 1-4 above
24:00 Choosing a pump for ECMO in USA
26:42 Controlled and catastrophic events during ECMO
controlled: oxygenator failing, clot forming, fiber degradation
catastrophic: acute decannulation, O2 source disconnected, pump head or oxygenator thrombosis, line or access port disconnection, air embolus, pump head failure, clamping wired portion of cannula, breaking a connector or stopcock port, turning certain stopcocks the wrong way
32:32 ECMO platform (ECMO Machine)
40:00 Configuration of ECMO
41:35 Pediatric ECMO circuit
52:47 ECMO tools to deliver
55:34 ECMO Basic components
56:23 ECMO pumps and systems
57:57 Abbot Thoratec Centrimag
1:02:14 Alung Hemolung RAS
1:05:16 Getinge Maquet Cardiohelp and Rotoflow RF -32 Pump
1:11:30 Inspiration Medos Deltastream System / Xenios Novalung
1:15:46 Livanova Sorin SCPC and TandemLife / TandemLung
1:24:08 Medtronic Bio-console with CP40 Pump Head
1:26:02 ECMO Tools Comparisons
1:34:36 ECMO Stuffing model pros and cons