ECMO AT THE U of M
• Two era’s 1974 & 1986
• 1974 - 12 patients. Kolobow Membrane
Lung – Roller Pump – Adult and Peds.
Patients. No Survivors
• 1986 to present - ? Patients. Several
different oxygenators, Centrifugal pump
only!
• ?% overall survival
CIRCIUTS FOR ECMO
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ARTERIAL VENOUS
VENOVENOUS
PERIPHERAL
CENTRAL (OPEN CHEST)
CANNULATION TECHNIQUE
NEONATE PERIPHERAL
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Neck cannulation
Positioning of patient
Sedation
Surgical Prep
Ideal Cannulae Position
Ideal Arterial Cannula
Placement A V ECMO
• Cannula in Ascending Aorta just above
Aortic valve (adjacent coronary ostia)
• Supplies oxygenated blood to
coronaries and the rest of the
circulation.
• Cannula tip should avoid proximity with
the Aortic valve leaflets and stay out of
left ventricle.
SINGLE CANNULA
VENOVENOUS
• Dual luman cannula
• Smallest size 14 fr. - limits use to
patients above 4 kg.
• 15 Fr. – 4kg to < 9kg two lenghts
• Flow recirculation 15-30%
• Requires higher flows
• No lung rest - must ventilate
• Requires good cardiac function
VENEO/VENOUS IN ADULTS
Peripheral cannulation
• Drainage from Femoral vein
• Return SVC via Jugular access
(Or visa versa)
• Access may be percutanious or direct cut
down
• Percutanious is better (less bleeding)
• Requires ventilation (no lung rest)
• Requires good cardiac function
VENO/ARTERIAL ADULTS
• Peripheral -Femoral vein, Femoral
Artery
– Limited distribution of blood centrally
– Must have reversal of flow in Aorta for
oxygenated blood to reach Heart and Brain
– Must place distal perfusion cannula in
Femoral artery
• Central cannulation - Aorta, Rt. Atrium
– Complete cardiopulmonary support