Book chapter
Daily Management of Patients on VV ECMO
Extracorporeal Membrane Oxygenation for Adults, pp.217-227
Respiratory Medicine, Springer International Publishing
2022
DOI: 10.1007/978-3-031-05299-6_12
Abstract
Daily management of patients on VV ECMO requires a multidisciplinary and collaborative approach. The managing physician judges gas exchange, reviews organ system function, identifies and prevents complications, and ensures communication between the ECMO specialists, bedside nurses, respiratory and physical therapists, and the patient or surrogate decision-makers. The circuit should be evaluated comprehensively, including membrane lung function, cannula sites, presence of fibrin, tightness of connectors, and securement of the entire circuit. Point-of-care ultrasound assesses cannula position, right ventricular function, and volemia. Interaction between patient and ventilator is judged to limit ventilator-induced lung injury while sweep gas flow is adjusted in line with the desired work of breathing. The multidisciplinary team should arrive at a daily plan for fluid management, weaning attempts (ventilator and ECMO), mobilization, anticoagulation, and whether to use prone positioning. Emergency preparedness (backup ventilator settings, reserve circuit, who to call) is reviewed for accuracy. Finally, the goal of ECMO should be revisited: is recovery or transplant still realistic?
Details
- Title: Subtitle
- Daily Management of Patients on VV ECMO
- Creators
- Charles Rappaport - University of Iowa Hospitals and ClinicsKristina Rappaport - University of Iowa
- Resource Type
- Book chapter
- Publication Details
- Extracorporeal Membrane Oxygenation for Adults, pp.217-227
- Publisher
- Springer International Publishing; Cham
- Series
- Respiratory Medicine
- DOI
- 10.1007/978-3-031-05299-6_12
- eISSN
- 2197-7380
- ISSN
- 2197-7372
- Language
- English
- Date published
- 2022
- Academic Unit
- Internal Medicine; Pulmonary, Critical Care, and Occupational Medicine
- Record Identifier
- 9984642344402771
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