"The history of extra-corporeal membrane oxygenation (ECMO) reflects a true medical success story that has been the result of tremendous dedication, perseverance, teamwork, and years-if not decades-of hard work by countless providers, students, and advocates. This book, the final in a series of three on ECMO, traces the history of extra-corporeal support from the early years when therapy was offered as a last attempt at salvaging those patients who had lost almost all hope of survival, to the modern era and the role of ECMO in the contemporary management of critically ill patients, especially during the COVID-19 pandemic. The chapters illustrate how the technical aspects of ECMO have evolved, as well as the growing role of patient selection and team-based management. Although the role of ECMO for COVID-19 is still evolving, the chapters addressing this topic can serve as a foundation for the many complex systematic issues, beyond just the bedside care of ECMO patients, that must be acknowledged. Jorge Agustâin Nicolâas Ruiz de Santayana y Borrâas, also known as George Santayana, has been credited with the quote: "Those who cannot remember the past are condemned to repeat it," [George Santayana (1905) Reason in Common Sense, p. 284, volume 1 of The Life of Reason] a concept that clearly resonates with those involved in ECMO program development, patient selection and management. As such, the primary goal of this text is to help scholars of all levels better understand where we have been and where we are going"--
Author(s): Michael S. Firstenberg
Series: Medical Procedures, Testing and Technology
Publisher: Nova Science Publishers
Year: 2021
Language: English
Pages: 230
City: New York
Contents
Preface: The Practice and Principles of Extra-Corporeal Membrane Oxygenation (ECMO) – Volume 3
Introduction
References
Introduction
The History of Extra-Corporeal Membrane Oxygenation From Start to COVID
Introduction
References
Chapter 1
The Genesis and Evolution of Extracorporeal Membrane Oxygenation
Abstract
Introduction
Early Hypotheses and Studies in Extracorporeal Membrane Oxygenation
Early Applications of Extracorporeal Oxygenation and Artificial Perfusion
From Cardiopulmonary Bypass to Prolonged Mechanical Circulatory Support — The Membrane Oxygenator
A Shifting Paradigm with Expanding Indications for ECMO
References
Chapter 2
An Introduction to VA-ECMO: Physiology, Indications, and Principles of Management
Abstract
Introduction
Anatomy of the Modern VA-ECMO Circuit
Mechanical Pumps
Modern Centrifugal Pumps
Basic Pump Management
Oxygenators and Gas Exchange
Membrane Oxygenators
Oxygen Delivery and Sweep Gas Flows
Monitoring and Titrating Gas Exchange
The Evolution of Polymethyl Pentene and Nonporous Hollow Fiber Membrane Oxygenators
Other Circuit Components and VA-ECMO Cannulation
Priming the Circuit and Storage of the ECMO Circuit
Cannulation Strategies and Cannula Selection
Indications and Contraindications
Indications for VA-ECMO in Cardiogenic Shock
Indications for VA-ECMO as Extracorporeal Cardiopulmonary Resuscitation (ECPR)
Decision Making and Defining Objective of VA-ECMO
Contraindications for ECMO
Physiologic and Pathophysiologic Hemodynamic Effects of VA-ECMO
Normal Mechanics of the Left Ventricle
Ventricular-Vascular Coupling: Interdependence of Preload, Afterload and Inotropy
Pressure-Volume Relationships in Acute Cardiogenic Shock
Hemodynamic Consequences of VA-ECMO
Cardiopulmonary Physiology Considerations in VA-ECMO
Monitoring and Managing Patients on VA-ECMO
Weaning and Complications
Weaning from VA-ECMO
End-Organ Complications on VA-ECMO
Recent Results and Future Directions
Conclusion
References
Chapter 3
Disaster Preparedness for ECMO Programs and Adapting ECMO Programs to Face the COVID19 Pandemic
Abstract
Introduction
Elements of Disaster Preparedness
Inventory and Preparation
Impact of Demand for General Critical Care Services
Revising Program Scope and Protocols for a Specific Disaster
Ethical Considerations
An Example: ECMO in the COVID-19 Pandemic
Early Experience with ECMO in COVID-19 Patients
Disaster Preparedness for COVID-19
Identifying Key Challenges: Minimizing PPE Burn Rate
Ethical Issues in Preparations for COVID-19
Conclusion
References
Chapter 4
Special Considerations for ECMO Cannulation and Decannulation for COVID-19 Patient
Abstract
Introduction
Patient Selection
ECMO Cannulation
Anticoagulation
Decannulation
Conclusions
Introduction
Patient Selection
Cannulation
VVA or VA Conversion
Anticoagulation
Decannulation
Pre-Decannulation Assessment
Decannulation
Conclusion
References
Chapter 5
The Use of ECMO for Treatment of Severe ARDS Due to Coronavirus Disease 2019
Abstract
Introduction
History of ECMO for ARDS Due to Viral Pneumonia
History of ECMO in COVID-19
ECMO Utilization in ARDS Due to COVID-19
Discussion
References
Chapter 6
Frontline Experience with Extracorporeal Life Support for COVID-19 Patients
Abstract
Introduction
Development of ECMO Guidelines for COVID-19
Specifics of ECMO Management in the COVID-19 Patient Population
Survival
ECMO Type and Cannulation
Renal Replacement Therapies and Blood Purification
Anticoagulation
Infectious Risk, Healthcare Staff and Patient Safety
Adjunctive Therapy
Conclusion
References
Chapter 7
Extracorporeal Membrane Oxygenation (ECMO) in COVID-19: The Role of Lung Transplantation
Abstract
Introduction
COVID-Positive Patients Who Are Unable to Separate from ECMO
COVID-Positive Patients Who Come off ECMO but Are Unable to Be Liberated from the Ventilator
COVID-Positive Patients Who Come off ECMO and Are Liberated from the Ventilator, but Are Unable to Achieve Meaningful Functional Recovery
COVID-Positive Patients Who Come off ECMO, Are Extubated and Achieve Meaningful Functional Recovery in the Short-to-Medium Term But Eventually Develop End-Stage Pulmonary Disease Requiring Evaluation for Transplantation
Conclusion
References
About the Editor
Index
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