Extracorporeal life support

Description

This book covers up-to-date knowledge of extracorporeal life support/ membrane oxygenation (ECLS/ECMO), which is performed as one special procedure that takes over the work of the lungs when they are too sick to properly support the body. ECLS has been recognized as one primary rescue strategy when the conventional treatments cannot reverse the process of cardiac dysfunction or respiratory dysfunction. During the recent years, ECLS has also been utilized as the bridge during peioperative organ transplantation, emergency cardiopulmonary resuscitation, and chronic assistant devices such as left ventricular assist device. This book summarizes the major characteristics of technique, current status of implication and topics of development. Physiology and mechanism of ECLS is defined in the initial part of the book. Type and primary characteristics of ECLS, including instrument materials and monitoring methods are further introduced. Methods of cannulation, characteristics of patients and key-point of management during pediatric ECLS are included. ECLS has been recognized as one kind of novel CPR procedures, transport of ECLS, treatment of various complications with preventive strategy are demonstrated. Recent hot topics of ECLS and training perspective are also discussed.  Preface Introduction of Chief Editor, Feilong Hei The Main Academic Title Scientific Research and Clinical Achievements Introduction of Chief Editor, Yulong Guan The Main Academic Title Scientific Research and Clinical Achievements Scientific Achievements Scientific Training Scientific Monographs Scientific Papers Introduction of Chief Editor, Kun Yu The Main Academic Title Scientific Research and Clinical Achievements Contents 1: Physiology of Extracorporeal Life Support Cardiovascular Physiology Heart Vasculature Blood Blood Composition Transportation of O2 in Blood Transportation of CO2 in Blood Cardiovascular Pathophysiology ECMO Circuit and Circuit Physiology Blood Pumps Roller Pumps Rotary Pumps Interaction Between Centrifugal Pump and Patient Gas Exchange Device: Artificial Oxygenator Blood Oxygenation in Oxygenator CO2 Removal in Oxygenator Other Functions of Oxygenator Cannulas Tubing and Connectors Mechanism of Cardiorespiratory Support Physiology of VA-ECMO Hemodynamic Effects of VA-ECMO Gas Exchange in VA-ECMO Advantages and Disadvantages of VA-ECMO Physiology of VV-ECMO Hemodynamic Effects of VV-ECMO Oxygenation in VV-ECMO CO2 Removal in VV-ECMO Recirculation During VV-ECMO Advantages and Disadvantages of VV-ECMO VA-ECMO vs. VV-ECMO Pharmacokinetics During ECMO Pumpless Extracorporeal Lung Assist (pECLA) Summary References 2: Equipment and Devices of Extracorporeal Life Support Blood Pump Centrifugal Pump Physics Components of a Centrifugal Pump Commercial Centrifugal Pumps Membrane Oxygenator Commercial Gas Exchange Devices ECLS Tubing General Principles of Circuit Design Surface Coating Technology Heat Exchanger/Heater-Cooler Device Medicare Monitoring During ECLS Hemoglobin Saturation Measurement Anticoagulation Monitoring Circuit Pressures Colloid Osmotic Pressure Plasma Free Hemoglobin Temperature Monitoring References 3: Types of Extracorporeal Life Support and Evolution of Extracorporeal Oxygenators The Retrospective Glance on the Historical Development of ECLS/ECMO and Extracorporeal Oxygenators Evolution of Extracorporeal Oxygenator and Its Use in Extracorporeal Life Support Development of High-Performance Extracorporeal Oxygenators for ECMO Use—High Gas Exchange Efficiency, Low Flow Resistance, and Plasma Leak-Tight Oxygenator Extracorporeal Membrane Oxygenation (ECMO) Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) Mode VV Configurations and Cannulation Strategies Special Consideration: Right Ventricular Failure During ARDS and VV ECMO Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) Mode VA Configuration and Cannulation Strategies Venovenous-Arterial (VV-A) ECMO, Alternative Configuration of Peripheral VA Mode and Cannulation Strategies Veno-Veno-Arterial (V-VA) ECMO, a “Hybrid” Mode Configuration in North-South or Harlequin Syndrome or Differential Hypoxia Conclusion References 4: Cannulation and Decannulation of Extracorporeal Life Support Cannulation Sites Femoral Artery Axillary Artery Carotid Artery Ascending Aorta Femoral Vein Right Internal Jugular Vein Subclavian Vein Right Atrium Cannula Selection Single-Lumen Cannula Dual-Lumen Cannula Methods and Techniques of Cannulation Surgical Cannulation Femoral Vessel Cannulation Neck Vessel Cannulation Axillary Artery Cannulation Central-VA ECMO Cannulation Percutaneous Cannulation Pre-Procedure Preparation Peri-Procedure Post-Procedure Semi-Percutaneous Cannulation Decannulation Decannulation of Arterial Cannula Decannulation of Venous Cannula Left Ventricular Venting Surgical Venting Sternotomy Mini-Thoracotomy Percutaneous Venting Transseptal Venting Transpulmonary Venting Transaortic Venting References 5: Anticoagulation During Extracorporeal Life Support Hemostatic Alterations Anticoagulation Unfractionated Heparin Direct Thrombin Inhibitors Antiplatelet Agents Anticoagulation Monitoring ACT aPTT Anti-Factor Xa Assay Thromboelastography/Thromboelastometry-Guided Algorithm Anticoagulation Management During ECLS Bleeding Thrombosis Conclusions References 6: Management of Pediatric Extracorporeal Life Support Overview and History Centrifugal Pump Takes the Place of Roller Pump Hollow Fiber Oxygenator Takes the Place of Silicon Membrane Oxygenator Cannula Circuit and Coating Technique Outcomes Indications Respiratory Failure Cardiac Support Perioperation Support of Heart Nonstructural Heart Disease Cannulation Strategies VA ECMO Neck Cannulation Central Cannulation Groin Cannulation VV ECMO Decannulation ECMO Circuit Priming Initiation of ECMO Selection of Cannula ECMO Flow ICU Management and Assessment of Support Ventilation Hypoxia Cardiac Output Fluid Management and Nutrition Sedation Anticoagulation Key Points in Management Systemic and Local Hypoxia Left Heart Decompression VA ECMO for Single Ventricle Special Situations Cannulation Site Care Hypertension Infection Bleeding and Thrombosis Weaning from ECMO References 7: Management of Adult Extracorporeal Life Support Monitoring Monitoring of ECLS Equipment Blood Flow Rate and Pump Rotation Speed Sweep Gas Flow Gas Exchange of Oxygenator Pressure Monitoring in the Circuits Water Tank Temperature Thrombus in the Circuits Patient’s Monitoring Hemodynamic Parameters Respiratory System Nervous System Gastrointestinal System Renal Function Blood System Respiratory and Circulatory Management VV ECLS Target Values Ventilator Management ECLS Blood Flow and Sweep Gas Flow Hemodynamics Patient Position VA ECLS Target Values Control Respiratory Management Hemodynamics Blood Management Hematocrit Destruction of Red Blood Cells Anticoagulation During Extracorporeal Life Support Kidney Function and Electrolytes Kidney Function Blood Gas Parameters and Electrolytes Management of Edema and Fluids The Mechanisms of Edema During ECLS Fluid Management During ECLS Central Nervous System Assessment of Central Nervous System During ECLS Central Nervous System Protective Measures During ECLS Gastrointestinal Tract Management and Nutritional Support Parenteral Nutrition Enteral Nutrition Nutritional Assessment Analgesia and Sedation Evaluation and Goals Commonly Used Drugs Conscious ECLS Temperature Management Vascular Complications Blood Vessel Damage Limb Ischemia Infection and Antibiotics Urinary Tract Infection Pulmonary Infections Intravascular Infection Caused by Indwelling Catheter Wound Infection Intestinal Infection Fungal Infection Discontinuation of ECLS Requirements for ECLS Discontinuation Testing Before Discontinuation VV ECLS VA ECLS Repeat ECLS Assistance Termination of Ineffective ECLS References 8: Extracorporeal Life Support During Cardiac Arrest Selection of ECPR Patients No Flow Time and Low Flow Time Age CPR Quality: EtCO2 Ventilator Setting Strategies of Cannulation Management Complications Neurological Outcome References 9: Adverse Events and Complications of Extracorporeal Life Support Categories of Complications and the Cumulative Incidence Mechanical Adverse Events Pump Failure Symptoms Causes Solution Low Flow/Cutting Off Symptoms Causes Solution Air in Circuit Symptoms Causes Solution Oxygenator Failure Symptoms Causes Solution Thrombosis Symptoms Causes Solution Tubing Rupture Symptoms Causes Solution Others Cannulation-Related Complications Clinical Manifestations Causes Solution Hematologic Disorders Thrombosis Incidence Clinical Manifestations Mechanisms Management of Thrombosis Bleeding Definition and Incidence Clinical Manifestations Mechanism Prevention and Management Neurologic Injury Clinical Manifestations Incidence Risk Factors Mechanism ICH AIS Hypoxic Ischemic Encephalopathy Seizures Prognosis Prevention Management Circulatory Complications LV Dilation Complications Harlequin Syndrome Pulmonary Complication Clinical Manifestations Causes Solution Acute Kidney Injury Definitions of ECMO-Associated Kidney Injury Risk Factors Pathophysiology of ECMO-Associated Kidney Injury Prevention and Management Vascular Complications Limb Ischemia Prevalence and Definition Mechanism Prevention Treatment Vessel Damage Clinical Manifestations Etiological Factor Prevention Treatment Infection Clinical Manifestations Risk Factors Etiology of Infection Preventive Practices Hemolysis Diagnosis and Clinical Manifestations Mechanisms Patient-Related Factors Circuit-Related Factors ECMO Set-Up and Management Factors Management and Prevention References 10: Transport of the Patients Supported with Extracorporeal Life Support Intra-Hospital Transport of Patients Supported with ECLS Purpose of Transport Preparation of Personnel and Equipment Transport Points Inter-Hospital Transport Indications for Inter-Hospital ECLS Transport Transport Logistics Transfer Modes Personnel Preparation Transport Equipment Management of Inter-Hospital ECLS Transport Assessment of Patient Lay Out a Scheme Patient Transport Monitoring in ECLS Transfer Treatment and Care in ECLS Transfer Complications Associated with Transport References 11: Extracorporeal Life Support During Perioperative Transplantation ECLS During Perioperative Heart Transplantation ECLS Prior to Heart Transplant Inclusion Criteria of ECLS Prior to Heart Transplant Current State of ECLS as a BTT in Adult Candidates ECLS as a BTT Before Pediatric Heart Transplantation ECLS as Post-Transplant Support Definition and Classification of PGD After Heart Transplant Advantage of ECLS for PGD Current State of ECLS for PGD Outlook of ECLS During Perioperative Heart Transplantation ECLS During Perioperative Lung Transplantation ECLS as a Bridge to Lung Transplant Advantage of ECLS as a Bridge to Lung Transplant Recommendations on the Use of ECLS in Bridge to Lung Transplant Factors That Affect Post-Transplant Survival in Patients on ECLS Support Current State of ECLS as a Bridge to Lung Transplant The Protocol of Implementation of ECLS as a BTT ECLS During Lung Transplantation Management of Ventilation and Oxygenation Transfusion and Anticoagulation Weaning from ECLS ECLS Following Lung Transplantation Clinical Experience Indications Time of Initiation Technical Aspects Outcomes of ECLS After Lung Transplantation Outlook of ECLS During Perioperative Lung Transplantation ECLS During Donor Storage Organ-Preservation ECLS in DBD Donor ECPR and Organ Donors ECLS for Abdominal Organ Protection from Donors After Circulatory Death Ethical Dilemmas of ECLS in Organ Donors References 12: Topics of Extracorporeal Life Support Novel ECLS Instruments Animal Experiments with Newly Developed ECLS System Clinical Experiments with Newly Developed ECLS System The Timing of ECLS Initiation Patient Selection and Timing for rECLS Support Bridge to Recovery Bridge to Transplant Patient Selection and Timing for cECLS Support Bridge to Recovery Bridge to Transplant or Mechanical Circulatory Support Extracorporeal Cardiopulmonary Resuscitation The Timing of ECLS Termination Weaning from VA ECLS Hemodynamics Respiratory Criteria End-Organ Recovery Criteria Flow Reduction Echocardiographic Assessment Weaning from VV ECLS ECLS During Treatment of COVID-19 When ECLS Is Used for COVID-19 Patients What Patients Are the Highest Priority? What Patients Should Be Excluded? ECLS During Donor Reconditioning of Lung Transplantation Patient Selection for ECLS ECLS and Protection During Reperfusion Combination of Mechanical Assistance with ECLS New Indications of ECLS in the Future References 13: Extracorporeal Life Support Training Teaching Theory Cognitive Domain Psychomotor Domain (Technical Skills) Psychomotor Domain (Behavioral Skills) Affective Domain Training of ECLS Team Training Content Acquiring Competency Didactic Course Water Drills Animal Lab High-Fidelity Simulation Verifying ECLS Competency Evaluation Ability Maintaining Competency Credentialing Ethics Training Ethical Dilemmas Ethics Content Skills for Managing Ethical Dilemmas ECLS Training in China Mainland Future Perspectives References