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Bruksområder[rediger | rediger kilde]
ECMO benyttes innen behandlingen av nyfødte med alvorlig nedsatt lungefunksjon. It is around 75% effective in saving the newborn's life. Newborns cannot be placed on ECMO if they are under 4 and a half pounds, thus ruling out the device for most premature newborns. Newborn infants are occasionally placed on ECMO due to the lack of a fully functioning respiratory system or other birth defect, but the survival rates drop to roughly 33%.
Prosedyre[rediger | rediger kilde]
An ECMO machine is similar to a heart-lung machine. To initiate ECMO, cannulae are placed in large blood vessels to provide access to the patient's blood. Anticoagulant drugs (usually heparin) are given to prevent blood clotting. The ECMO machine continuously pumps blood from the patient through a "membrane oxygenator" that imitates the gas exchange process of the lungs, i.e. it removes carbon dioxide and adds oxygen. Oxygenated blood is then returned to the patient.
Management of the ECMO circuit is done by a team of ECMO specialists that includes ICU physicians, perfusionists, respiratory therapists and registered nurses that have received training in this specialty.
Typer[rediger | rediger kilde]
Det finnes forskjellige former for ECMO, de to mest vanlige er venøs-arteriell (VA) og veno-venøs (VV). Ved begge modaliteter dreneres venøst blod fra kroppen og blir oksygenert utenfor denne. Ved VA returneres blodet til arteriesiden, og ved VV returneres blodet til venesiden. Ved VV ECMO tilbys ingen understøttelse av hjertefunksjonen.
Varighet[rediger | rediger kilde]
VV ECMO can provide sufficient oxygenation for several weeks, allowing diseased lungs to heal while the potential additional injury of aggressive mechanical ventilation is avoided. It may therefore be life-saving for some patients. However, due to the high technical demands, cost, and risk of complications (such as bleeding under anticoagulant medication), ECMO is usually only considered as a last resort therapy.
The time limit for a newborn is usually around 21 day max. Dr. Thomas Krummel, Chairman of General Surgery at Stanford University, held the record for the longest survivor on ECMO at 62 days. This record was in turn broken recently on January 30, 2008, when a patient at NTU hospital, Taiwan survived a drowning accident after 117 days of ECMO application.
Komplikasjoner[rediger | rediger kilde]
ECMO can have dangerous side effects. The large catheters inserted in the baby's neck can provide a fertile field for infection, resulting in fatal sepsis.
Additional complications include a greatly increased risk of bleeding. In adults, ECMO survival rates are around 60%, and there are reports of patients being supported for over ten weeks. ECMO has yet to have proven survival benefit in adults with ARDS.
In VA ECMO, patients whose cardiac function does not recover sufficiently to be weaned from ECMO may be bridged to a ventricular assist device (VAD) or transplant.