LABORATORY OF BIOLOGICAL STRUCTURE MECHANICS
www.labsmech.polimi.it
Technical and biological advances in ECMO
Maria Laura Costantino
New Perspective in ECMO 2012
III International Meeting
Milan, 5 October 2012
Extracorporeal Membrane Oxygenation(ECMO)
ECMO is the use of a modified extracorporeal circuit to
provide temporary mechanical support (respiratory and/or
cardiac) to patients failing conventional intensive therapy.
ECMO has brought the technology of cardiopulmonary
bypass to bedside under the management of ECMO
specialists and intensive care physicians.
Maria Laura Costantino
History
1917 – J Mac Lean discovered Heparin (which was
introduced in clinical practise in 1938).
1930 – JH Gibbon - First extracorporeal circulation system.
Maria Laura Costantino
History
1917 – J Mac Lean discovered Heparin (which was
introduced in clinical practise in 1938).
1930 – JH Gibbon - First extracorporeal circulation system.
Dr & Mrs Gibbon with
their CPB machine
Maria Laura Costantino
History
1917 – J Mac Lean discovered Heparin (which was
introduced in clinical practise in 1938).
1930 – JH Gibbon - First extracorporeal circulation system.
1950 – Early Developements of CPB.
1956 – GHA Clowes Jr. – Plastic Membrane Oxygenator.
1957 – K Kammermeyer – Use of thin Silicone Membranes.
Early ’60s – T Kolobow designed his “Membrane Lung”.
1972 – JD Hill reported first successful case of prolonged
extracorporeal support in humans: Adult ECMO
Maria Laura Costantino
History
Maria Laura Costantino
History
1917 – J Mac Lean discovered Heparin (which was
introduced in clinical practise in 1938).
1930 – JH Gibbon - First extracorporeal circulation system.
1950 – Early Developements of CPB.
1956 – GHA Clowes Jr. – Plastic Membrane Oxygenator.
1957 – K Kammermeyer – Use of thin Silicone Membranes.
Early ’60s – T Kolobow designed his “Membrane Lung”.
1972 – JD Hill reported first successful case of prolonged
extracorporeal support in humans: Adult ECMO
1975 – RH Bartlett - First Successful Neonatal ECMO
1986 – L Gattinoni - 50% Survival in Adult ECCO2R
1989 – ELSO Registry
Maria Laura Costantino
History
1917 – J Mac Lean discovered Heparin (which was
introduced in clinical practise in 1938).
1930 – JH Gibbon - First extracorporeal circulation system.
1950 – Early Developements of CPB.
1956 – GHA Clowes Jr. – Plastic Membrane Oxygenator.
From
then on, over and over increasing number
1957 – K Kammermeyer
– Use
of thin Silicone
Membranes.
of centres are
performing
either
Early ’60s – T Kolobow
his ECMO
“Membrane Lung”.
adult ordesigned
neonatal
1972 – JD Hill reported first successful case of prolonged
extracorporeal support in humans: Adult ECMO
1975 – RH Bartlett - First Successful Neonatal ECMO
1986 – L Gattinoni - 50% Survival in Adult ECCO2R
1989 – ELSO Registry
Maria Laura Costantino
ECMO Types
The type of ECMO depends on the patient’s underlying
cardiac function.
Veno-Arterial (V-A) ECMO
Veno-Venous (V-V) ECMO
• Provides support for severe
cardiac and respiratory failure,
most commonly after cardiac
surgery.
• Induces high hemodynamic
disturbances depending on the
chosen return access sites.
• Can be used as a bridge to
cardiac recovery or to another
destination therapy.
• Provides support for severe
respiratory failure when
reasonable heart function is
assessed.
• Induces low hemodynamic
disturbances.
• 1 or 2 access cannulae can be
used depending on the
bypassed blood flow.
Maria Laura Costantino
ECMO Types
Veno-Arterial (V-A) ECMO
Veno-Venous (V-V) ECMO
Second
Access Cannula
SVC
Return Cannula
FA
Access
Cannula
FV
Return Cannula
IVC
Access Cannula
IVC
Maria Laura Costantino
ECMO Circuit
Equipment
•
•
•
•
•
Outflow cannula
Inflow cannula
Pump
Oxygenator
Lines
Patient
Gas
Source
Main Issues
•
•
•
•
•
Efficacy
Priming Volume
Haemolysis
Compatibility
Duration
Maria Laura Costantino
Pump
Membrane
Lung
ECMO main technical advances are in 4 areas
1) A move from VA to VV ECMO: helped by the
widespread use of a wide size range of double-lumen
veno-venous cannulae.
DL VV
catheter
Return (arterial)
lumen
Outflow
(venous) lumen
Maria Laura Costantino
ECMO main technical advances are in 4 areas
1)
A move from VA to VV ECMO: helped by the widespread use of a wide
size range of double-lumen veno-venous cannulae.
2) A move from roller to centrifugal pumps that do not
damage the red cells (most main pump manufacturers
have systems).
Centrifugal Pump
Drive Unit
Roller Pump
Console
Roller Pump Head
Centrifugal Pump
Head
Maria Laura Costantino
Centrifugal Pump
Console
ECMO main technical advances are in 4 areas
1)
2)
A move from VA to VV ECMO: helped by the widespread use of a wide
size range of double-lumen veno-venous cannulae.
A move from roller to centrifugal pumps that do not damage the red cells
- most main pump manufacturers have systems.
3) A switch from silicone membrane oxygenators to
polymethylpentene hollow fibre ones.
Silicone membrane
oxygenator unravelled
Maria Laura Costantino
ECMO main technical advances are in 4 areas
1)
2)
3)
A move from VA to VV ECMO: helped by the widespread use of a wide
size range of double-lumen veno-venous cannulae.
A move from roller to centrifugal pumps that do not damage the red cells
- most main pump manufacturers have systems.
A switch from silicone membrane oxygenators to polymethylpentene
hollow fibre ones.
4) Miniturisation of circuits: all the above have allowed
circuit miniturisation, have facilitated transport on ECMO
and have allowed us to run with much less Heparin,
thus reducing bleeding risk.
Maria Laura Costantino
16
Thank you for your
attention
Maria Laura Costantino