ECMO-Extracorporeal Life Support in Adults

489 Pages·2014·9.03 MB·English

by  Fabio Sangalli

ECMO-
Extracorporeal Life
Support in Adults
Fabio Sangalli
Nicolò Patroniti
Antonio Pesenti
Editors
123
ECMO-Extracorporeal Life Support in Adults

Fabio Sangalli (cid:129) N icolò Patroniti
Antonio Pesenti
Editors
ECMO-Extracorporeal Life
Support in Adults
Editors
Fabio Sangalli Antonio Pesenti
Department of Anaesthesia Health Science Department
and Intensive Care Medicine Università Milano Bicocca Facoltà
San Gerardo Hospital Medicina e Chirurgia
Monza (MB) Monza (MB)
Italy Italy
Nicolò Patroniti
Health Sciences Department,
Urgency and Emergency Department
Milano-Bicocca University
San Gerardo Hospital
Monza (MB)
Italy
ISBN 978-88-470-5426-4 ISBN 978-88-470-5427-1 (eBook)
DOI 10.1007/978-88-470-5427-1
Springer Milan Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014934677
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Foreword
T he best way to temporarily support or substitute vital organs is based on the avail-
ability of reliable and effective tools able to vicariate the failing natural organ. This
opportunity was achieved long ago for the kidney and, later on, for the heart and
lung. The technological improvement that miniaturized the apparatus improved the
vascular access, increased the performance of the artifi cial support, and has allowed
to expand the use of circulatory and respiratory extracorporeal support to several
clinical situations and to different ICUs (cardiac, respiratory, general). The advent
of new fulminant diseases (H1N1 respiratory failure) and the improvement of out-
of-hospital care for cardiac arrest are two situations that recently have seen extracor-
poreal support as a possible life-saving application. In order to correctly use the new
technologies, a specifi c competency and skills should be developed and imple-
mented: as it happens for the achievement of positive results in the ICU setting, the
entire team (perfusionists, nurses, and doctors) has to be trained and should have
specifi c knowledge of the new technologies. Moreover, in this time where the ade-
quate allocation of resources appears to be very important, it is mandatory that the
indications for the use of expensive and long-lasting techniques should be accu-
rately weighed and shared among professionals.
The aim of this book is to provide readers with the theory and practical issues
that experts in the fi eld of extracorporeal circulatory and respiratory support believe
could help in understanding and improving the practice of this medical device.
Milan, Italy Roberto Fumagalli
v

Pref ace
E xtracorporeal membrane oxygenation (ECMO) is not a new technique. It has been
used in clinical practice for the last four decades, but the complexity of management
and the relevant complications limited its diffusion to few specialized centers.
I n recent years, the development of new materials and the simplifi cation of the
procedure led to a dramatic increase in the centers providing extracorporeal life sup-
port (ECLS) and in the number of ECMO runs, for both respiratory and circulatory
indications.
A growing number of publications on all aspects pertaining to ECLS are populat-
ing the medical literature.
D espite this expansion in the use of ECLS and in ECLS-related research, the
clinical management of ECMO remains mainly based on local protocols and proce-
dures, and guidelines are lacking on many aspects of this practice. The ELSO
(Extracorporeal Life Support Organization) registry and website, together with their
so-called Red Book, represent the most authoritative resource, and many websites
provide protocols and management guidelines from different ECMO centers. Still,
such indications are mainly locally based or not regularly updated.
For this reason we tried to collate the most relevant aspects pertaining to ECLS,
following two different approaches. Some chapters present an in-depth analysis of
the current evidence and literature on the different indications, while other chapters
face technical aspects with a more practical approach. These latter chapters are
obviously infl uenced by the practice in the authors’ centers, but we tried to integrate
this with literature and different experiences whenever possible, particularly for the
aspects where centers’ attitudes diverge, such as left ventricle venting, cannulation
techniques, and management of the lung during respiratory support, to name some.
ECLS remains a fast-evolving technique and some aspects still need research
and optimization. Some of these are outlined in the conclusive chapter of the book,
but more are still to be faced. Ample bibliographic references are provided at the
end of every chapter for the interested reader to further explore specifi c aspects.
ECLS represents a relatively easy technique, but it is not simply a “procedure” to
be learned and performed. ECMO is an excellent tool for organ support, but it
requires sound physiologic and pathophysiologic knowledge and needs to be com-
bined with top-level standard care.
vii
viii Preface
We are aware that, as a fi rst edition, the readers will fi nd aspects of the book that
might be improved, and we will welcome any suggestion in this regard. We still
hope that the present work will be useful in disseminating ECLS knowledge and
stimulate further study and research.
Fabio Sangalli, Nicolò Patroniti, Antonio Pesenti, Monza (MB), Italy
Contents
Part I History and Technical Aspects
1 History of Extracorporeal Life Support . . . . . . . . . . . . . . . . . . . . . . . 3
Fabio Sangalli, Chiara Marzorati, and Nerlep K. Rana
2 Developing a New ECMO Program . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Antonio F. Arcadipane and Giovanna Panarello
3 Basic Aspects of Physiology During ECMO Support . . . . . . . . . . . . 19
Vittorio Scaravilli, Alberto Zanella, Fabio Sangalli,
and Nicolò Patroniti
4 Percutaneous Cannulation: Indication, Technique,
and Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Maurizio Migliari, Roberto Marcolin, Leonello Avalli,
and Michela Bombino
5 Surgical Cannulation: Indication, Technique, and Complications . 49
Francesco Formica, Silvia Mariani, and Giovanni Paolini
6 Materials: Cannulas, Pumps, Oxygenators . . . . . . . . . . . . . . . . . . . . 65
Umberto Borrelli and Cristina Costa
7 Coagulation, Anticoagulation, and Infl ammatory Response . . . . . . 77
Marco Ranucci
Part II ECMO for Circulatory Support
8 Extracorporeal Life Support: Interactions
with Normal Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Michele G. Mondino, Filippo Milazzo, Roberto Paino,
and Roberto Fumagalli
9 ECMO for Ischemic Cardiogenic Shock . . . . . . . . . . . . . . . . . . . . . . . 105
Francesco Formica, Fabio Sangalli, and Antonio Pesenti
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