Essay: Extracorporeal Membrane Oxygenation the Principles of Ecmo for Adults

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ECMO

An Overview of Extracorporeal Membrane Oxygenation: The Principles of ECMO for Adults

Extracorporeal membrane oxygenation (ECMO) is now several decades into use, yet is still a somewhat controversial procedure in adults despite being a well-established practice for infants and some older children (Mielck & Quintel 2005). New technologies have greatly improved the process and made it a standard part of severe cardiopulmonary derangement due to disease or injury, but only after the exhaustion of other interventions (Mielck & Quintel 2005; Yang 2011). There are different forms of ECMO with different direct impacts and specific variations from techniques such as cardiopulmonary bypass, but in the most common ECMO types blood still passes through the lungs (and in some types part of the heart) after passing through an external pump and oxygenator, while in cardiopulmonary bypass the heart and lungs are entirely bypassed (Yang 2011). Acute respiratory distress syndrome, alveolar capillary dysplasia, and many other causes of severe pulmonary failure that is thought to be reversible warrant the use of ECMO (Schuerer et al. 2008; Yang 2011).

Certain congenital defects and other conditions that render the cardiopulmonary irreversible are grounds for exclusion of an ECMO intervention, otherwise the procedure is deemed appropriate as a final attempt intervention and is routinely used on infants and older adults (Schuerer et al. 2008; Yang 2011). In typical ECMOs, blood is taken from the venous system and pushed through an extracorporeal gas exchanger that mimics the lungs, removing carbon dioxide and adding oxygen to the blood, after which the blood is returned wither to the right side of the heart or directly into the arterial system (Yang 2011). Silicone membrane gas exchangers are being replaced by hollow fiber oxygenators, which are more efficient, and other technological changes including centrifugal pumps, inline pumps, and improved carbon-dioxide removal methods that decrease ventilator resource needs are all improving the technique (Yang 2011; Mielck & Quintel 2005). These newer pumps, especially centrifugal pumps, are more appropriate for adult ECMO procedures (Yang 2011).

VA (venoarterial) ECMO, which places the blood directly into the arterial system with the pressure of the external pump behind it, is indicated in cases where the heart itself if impaired and/or blood pressure is dangerously low, while VV (venovenous) ECMO allows the heart to function normally (Yang 2011). It is the inclusion or the bypassing of the heart and/or lungs that constitutes the major difference between VA and VV ECMO. Cannulation typically occurs in the right… [END OF PREVIEW]

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Extracorporeal Membrane Oxygenation the Principles of Ecmo for Adults.  (2011, October 13).  Retrieved July 23, 2019, from https://www.essaytown.com/subjects/paper/extracorporeal-membrane-oxygenation/8581

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"Extracorporeal Membrane Oxygenation the Principles of Ecmo for Adults."  Essaytown.com.  October 13, 2011.  Accessed July 23, 2019.
https://www.essaytown.com/subjects/paper/extracorporeal-membrane-oxygenation/8581.