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ECMO Physiology and Management Exam
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ECMO Physiology and Management ExamExplain the basic mechanics of ECMO. ANSWER: Blood is drained from the
patient.
-the blood is oxygenated, and excess CO2 is eliminated.
Blood is warmed.
The blood is then returned to the patient.
-ECMO blood combines with the patient's blood.
ECMO Equipment - Pump
-Blender/Flow Meter
-membrane oxygenators
-heater
ECMO primarily serves as an oxygen delivery device.
O2 delivery: ANSWER DO2
Definition of oxygen delivery (DO2): the amount of oxygen given to peripheral
tissues per minute.
O2 supply = − O2 content x blood flow (cardiac output).
CO (cardiac output) = - ANSWER HR * stroke volume
oxygen content - ANSWER CaO2
,CaO2 = − O2 bound + dissolved O2.
The primary factor influencing ECMO oxygen exchange is the blood flow rate.
ECMO oxygen exchange is somewhat sensitive on ANSWER O2 concentrations.
ECMO oxygen exchange will be affected by ANSWER membrane surface area and
oxygenator efficiency.
CO2 exchange depends on three factors: ANSWER - relative concentrations (rate
of transfer 6 times larger than O2).
- Membrane surface area
-Gas flow rate
Increasing the sweep gas flow rate... - ANSWER "blows off" additional CO2
CO2 exchange is approximately ________________ of blood flow rate. -
ANSWER is independent.
How can you improve oxygen supply to a patient on ECMO? - ANSWER -
Increase ECMO flow.
-Increase hemoglobin
-Optimize the position for ECMO blood delivery
-Increase the sweep FiO2.
-Natural heart and lung function (minor role)
, Oxygen consumption - VO2
Normal VO2 in infants is 5-8 ml/kg/min.
Normal VO2 in children: 4-6 mL/kg/min.
Normal VO2 in adults: 3-5 ml/kg/min.
Sick newborn VO2: 10-12 ml/kg/min.
ANSWER Tissue metabolism regulates oxygen consumption.
ANSWER: Rest, paralysis, and hypothermia cause lesser oxygen consumption.
Oxygen consumption is enhanced with muscle activity, infection, heat, and
increased levels of catecholamines or thyroid hormones.
VO2 = - ANSWER Arterial oxygen delivery minus venous oxygen delivery.
Which equation can be used to calculate oxygen consumption (VO2)? - ANSWER
Fick Equation
Normal DO2 is - ANSWER five times VO2.
Normal DO2 is five times the VO2, resulting in a SvO2 of approximately 80%.
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