ECMO介绍-台大医院

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1、ECMOIntroduction台大醫院外科加護病房柯文哲醫師ECMOIntroductionDr.Wen-JeKoSICU,DepartmentofSurgeryNationalTaiwanUniversityHospitalECMOextracorporealmembraneoxygenation(體外膜氧合器)(艾克膜)(體外維生系統)ECMOextracorporealmembraneoxygenation(ExtracorporealLifeSupport)ECMOprolongedpartialca

2、rdiopulmonarybypassECMOvsCPBVeneousreservoirCPBvsECMOECMOShort-termcardiopulmonarysupportBuytimetodecidethenextstepRecoveryTransplantationlong-termdevice(ventricularassistdevice)Operation(CABG,pulmonaryembolectomy,..)Give-upforlung1.support:O2supply&CO2removal

3、2.rest:reduceventilatorinducedlunginjuryforheartsupport:improvesystemicperfusionrest:↓catecholamine↓myocardialworkdecreasepreloadrequirementandcongestionECMOTypeVV-ECMOVA-ECMOVV-ECMOindication:forlungdiseaseonlypurpose:todecreasebarotrauma(topreventventilator-

4、inducedlunginjury)ventilatorsetting:PCmode,PEEP>10,PIP<35,VR-->PaCO2,FiO2-->PaO2VA-ECMOadvantage:1.bothlung&heartsupport2.higherPaO2AnExampleofMCSECMOVADHTxDifferentpatientsDifferentsituationsDifferenttreatmentsIndicationsofECMOinthenearfutureAsamechanicalcir

5、culatorysupport:Post-cardiotomycardiogenicshockDoublebridge(ECMOVADHTx)AcutemyocarditisAMIcardiogenicshock(ECPR)ReplaceCPB:LungtransplantationNeurosurgeryNon-heart-beating-donorsupportRescueforacutepulmonaryembolismVentilatorysupportARDSNeonatalpulmonarydise

6、ases