(精编)【体外膜肺ECMO精品课件】 ECHOCARDIOGRAPHIC MONITORING ON ECMO教学课件.pptVIP

ECHOCARDIOGRAPHIC MONITORING ON ECMO;ECMO is a rescue therapy used to provide cardiac and/or respiratory support for critically ill patients in whom maximal conventional medical management has failed. V-V ECMO: provides adequate oxygenation and carbon dioxide removal in isolated refractory respiratory failure. V-A ECMO: when support is required for cardiac and/or respiratory failure.;Patient selection;Patient selection;Chiari’s network: review of the literature, Marios Loukas et al., Surg Radiol Anat (2010) 32:895–901;Pt selection ;Pt selection ;Patient selection;Insertion and correct placement of cannulas ;Insertion and correct placement of cannulas ;Insertion and correct placement of cannulas ;Insertion and correct placement of cannulas ;Insertion and correct placement of cannulas ; The return cannula should be in the mid right atrium. The access cannula tip should be in the proximal IVC. ;Echo is essential to check position of the cannulas in relation to IAS, PFO, LA, TV, CS etc. Incorrect cannula position can lead to: ;Avalon cannula;Patient selection;Underlying LV dysfunction;Adequate LV unloading;;Adequate LV unloading is vital;Catena et al.,”Role of Echocardiography in the perioperative managment of mechanical circulatory support”. Best practice Reserach Clinical Anaesthesiology 26 (2012);Adequate LV unloading;Adequate Venous Pressure unloading;Adequate Venous Pressure unloading;Monitoring of the Pt on V-V ECMO ;Patient selection;ECMO Complications;*;“The Role of Echocardiography and Other Imaging Modalities in Patients With Left Ventricular Assist Devices”. Jerry D. J Am Coll Cardiol Img. 2010;3(10):1049-1064.;Obstruction of the IVC: - Liver and splanchnic organs congestion;Obstruction of the IVC;Venous Flow obstruction ;Tamponade;Interatrial septum Coronary sinus Across the tricuspid valve Through a patent foramen ovale and into the LV;Augoustides J et al.. J Cardiothorac Vasc Anesth 17:113-120, 2003;Patient selection;clinical judgment;Echocardiograph