CM JAYALALITHA RELATED TREATMENT: Dr K K Aggarwal National President Elect, IMA

(CM JAYALALITHA RELATED TREATMENT)

Know about Extra corporeal membrane oxygenation (ECMO)

—-Dr K K Aggarwal
National President Elect, IMA—-

What is ECMO?
ECMO is a type of prolonged mechanical cardiopulmonary support that is usually delivered in the intensive care unit. ECMO is performed by clinicians with training and experience in its initiation, maintenance, and discontinuation.

How does it function?
During ECMO, blood is drained from the native vascular system, circulated outside the body by a mechanical pump, and reinfused into the circulation. While outside the body, the blood passes through an oxygenator and heat exchanger. In the oxygenator, hemoglobin becomes fully saturated with oxygen, while carbon dioxide (CO2) is removed. Oxygenation is determined by flow rate, where elimination of CO2 can be controlled by adjusting the rate of countercurrent gas flow through the oxygenator.

What are the types?
ECMO can be venovenous (VV) or venoarterial (VA):

● During VV ECMO, blood is extracted from the vena cava or right atrium and returned to the right atrium. VV ECMO provides respiratory support, but the patient is dependent upon his or her own hemodynamics.

● During VA ECMO, blood is extracted from the right atrium and returned to the arterial system, bypassing the heart and lungs. VA ECMO provides both respiratory and hemodynamic support. The additional benefit of hemodynamic support comes with additional risks.

VV ECMO is used in patients with respiratory failure, while VA ECMO is used in patients with cardiac failure.

Who is given ECMO?
Patients with severe, but potentially reversible, acute respiratory or cardiac failure that is unresponsive to conventional management are evaluated for ECMO.