provides support for respiratory only. Blood drained and returned to the right atrium so oxygenated blood returns to pt’s venous circulation
VA
Veno-arterial
Provides circulatory and respiratory support, pulls blood from the right atrium and puts back into aorta so oxygenated blood returns to pt’s arterial circulation
Sweep
The function of Sweep is CO2 removal
More sweep blows off more CO2 and vice versa
RT Specifics
For report, you need to know
Sweep rate for CO2 removal
FiO2 of sweep gas
When on ECMO, the patient will be placed on “resting” ventilator settings, typically bivent mode
ECMO pts tend to have very little to no volume movement during the start of ECMO. This comes from poor lung function as well as resting settings meant to hold the lungs somewhat open without causing damage as the healing process happens.
Our issues:
The heater requires at least 0.5 Lpm of flow through it to function. ECMO patients do not have this due to the hold on i-time and the low respiratory rate with little to no volume movement. The bleed in is used to keep the heater functioning with forward flow, so when the lung starts to recover, the air is humidified. It also helps our low minute ventilation alarm issue.
Triggering: If the patient is not moving any volume they will not be able to trigger any flow or pressure from the ventilator and are typically paralysed. However, this is why we turn off the flow to assess volume movement. When you see enough volume movement ie: minute ventilation of 0.5 or greater, turn off the bleed-in. This returns the triggering to the patient.
THINGS TO REMEMBER:
We chart all pressures with the flow on and all volume readings with the flow off. The pressures are real with the flow on and the volume read outs arent real with the flow on. So we turn the flow off to chart what the true volumes are. They look at these true volumes to determine when lung recruitment practices should start.
The flow is bleed in from a blended source with the same Fi02 that the ventilator is set to
The flow is bleed in on the inspiratory side, pre-heater and pre iNO injector if iNO is being delivered.
The flow rate should be 1 Lpm. This moves the minute ventilation reading from zero to 1.0. We shouldnt need more than 1 Lpm to fix the heater or minute ventilation alarm issue.
Once the patient starts to move enough Volume, ie: Ve of 0.5 or greater, turn off the bleed-in.
We chart the bleed-in in the ventilator comments.
Sometimes the PIP is ordered to 20 cmh20 and the bleed-in makes it push to say 22. We will lower the knob setting to adjust. Remember we set the ventilator as such to deliver the ordered pressure to the patient. Not the knob on the ventilator. So, we will target the measured PIP here and set the knob in a fashion so the patients PIP measures what the ordered PIP reflects.
As lungs begin to show improvement, therapies such as CPT or IPV may be initiated. RT Responsibilities if IPV is initiated for patients on ECMO are:
To communicate with ECMO specialists to ensure CO2 levels are being monitored and sweep adjusted as necessary
Watch NIRS
The following information will be given to the RT assigned to the patient to prepare for cannulation. It is a yellow card and must be completed and returned to the ECMO specialist
Respiratory Task List for ECMO Cannulation & Initiation
Pre Cannulation:
Cannulation in OR? Go with patient
EPOC ready - to check Prime Gasses
Patient is not charged for these gasses – ECMO primer MUST see/record results!
CXR plate under patient before draping
Do NOT use tray under the neonatal radiant warmers (will not image cannula site)
Use digital X-Ray plate (has ~3 hours of battery life – use max charge avail)
Maintain airway during Cannulation
HFOV will not alarm if kinked; maintain wiggle
Assess for O2 Fire Hazards while draped
i.e. secondary to concerns with cautery, no O2 under drapes
Post Cannulation:
Begin vent weaning per Attending orders (rest settings)
Emergency vent settings posted on ventilator (obtain form from ECMO)