Unit 26 ECMO Case

Sometimes despite optimal care, some patients become severe developing refractory hypoxemia. In this case extracorporeal membrane oxygenation or ECMO is the last hope. ECMO, a highly invasive procedure similar to a cardiopulmonary bypass machine comes with significant risk and complications, with rates of mortality near 60%.26 ECMO involves a skilled group of caregivers capable of monitoring and managing the patient correctly. Two different methods can be used, veno-atrial which requires a venous cannula placed in the right femoral vein to extract a patient’s blood, and a arterial cannula placed into the right femoral artery for infusion. Veno-venous is another method used which requires a cannula in the right common femoral vein for extraction …show more content…
“Characterized by the application of airway pressure to increase trans pulmonary pressure transiently”28 recruitment maneuvers attempt to open atelectatic areas of the lung and help improve gas exchange. Such maneuvers as sustained inflation, incremental PEEP or high pressure controlled ventilation all are common amongst physicians and respiratory therapists attempting to improve a patient’s outcome. Sustained inflation, being the most popular form of recruitment maneuver amongst physicians “consists of pressurizing the airways at a specific level and maintaining it for a given duration.”29 The most common method being raising airway pressure to 40 cmH2O for 40 seconds. The extended sigh technique consists of lower pressure levels slowly increasing. This method involves high PEEP in the pressure controlled mode. In a study done to evaluate the effect of recruitment maneuvers researchers concluded that “recruitment maneuvers were safe and useful to improve oxygenation and lung compliance in patients with severe ARDS” 30with PaO2/FiO2 ratio increasing in all patients performed though no significant reduction in