ECM介紹臺大醫(yī)院

1、ecmo introduction臺大醫(yī)院 外科加護(hù)病房柯文哲 醫(yī)師 ecmo introductiondr. wen-je kosicu, department of surgerynational taiwan university hospitalecmoextracorporeal membrane oxygenation(體外膜氧合器)(艾克膜)(體外維生系統(tǒng))ecmoextracorporeal membrane oxygenation(extracorporeal life support)ecmo prolonged partial cardiopulmonary bypass

2、ecmo vs cpb veneous reservoircpb vs ecmo cpb ecmo site or icu venous reservoir yes no heparin (act) 600 120-180 autotransfusion yes no hypothermia yes no hemolysis yes no hemodilution yes no arterial filter yes no ecmo short-term cardiopulmonary support buy time to decide the next step recovery tran

3、splantation long-term device (ventricular assist device) operation (cabg, pulmonary embolectomy,.) give-upfor 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 pre

4、load requirement and congestionecmo typevv - ecmova - ecmovv-ecmo indication : for lung disease only purpose : to decrease barotrauma ( to prevent ventilator-induced lung injury) ventilator setting : pc mode, peep 10 , pip paco2, fio2- pao2va-ecmo advantage : 1. both lung & heart support 2. high

5、er pao2an example of mcsecmovadhtx different patients different situations different treatmentsindications 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