Extracorporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is an advanced cardiopulmonary bypass machine used in cardiac surgery and can be lifesaving in patients with severe but reversible respiratory failure and/or or cardiac failure, refractory to conventional therapy. ECMO is not a cure for the underlying disease, but it is used as temporary support and offers time for the recovery of organs. Moreover, it can be used as a bridge to a more permanent device or cardiac transplantation.

The ECMO circuit basically consists of a vascular cannula, a pump, and an artificial lung (oxygenator). It can be set in to two main configurations. Veno-venous (V-V) ECMO provides lung support, while veno-arterial (V-A) ECMO provides both heart and lung supports. Initially, ECMO was used in neonatal and pediatric populations to treat respiratory failure. Over time, with the accumulation of experience and advances in technology, the application of ECMO has been extended, and the number of adult patients receiving this therapy has substantially increased. In this review, we sought to summarize patient selection, indications, contraindications, complications, technical aspects, and outcomes of ECMO.

Keywords

• Extracorporeal membrane oxygenation,respiratory failure,cardiac failure,patient selection

Ekstrakorporal Membran Oksijenizasyonu

Abstract

Ekstrakorporal membran oksijenizasyonu (ECMO), kardiyak cerrahide kullanılan kardiyopulmoner-baypas makinesinden geliştirilmiştir ve geleneksel tedaviye yanıt vermeyen şiddetli ama geri dönüşlü respiratuvar ve/veya kardiyak yetmezlikte yaşam kurtarıcı olabilmektedir.  ECMO altta yatan hastalığı iyileştirmez ancak organların toparlanabilmesi veya kalıcı bir cihaz yerleştirilmesi ya da transplantasyon yapılabilmesi için gereken zamanı kazandıran geçici bir çözüm sağlar. ECMO devresi basitçe vasküler kanüller, pompa ve yapay akciğerden (oksijenatör) oluşmaktadır. İki konfigürasyonda yerleştirilebilir; venö-venöz (VV) ECMO sadece respiratuar destek için  kullanılırken venö-arteriyel (VA) ECMO hem kardiyak hem respiratuar destek için kullanılmaktadır. Başlangıçta ECMO, yenidoğan veya pediatrik hasta gruplarının respiratuar yetmezliği tedavisinde kullanılırken yıllar içinde teknolojik gelişmelere ve artan tecrübeye paralel olarak kullanım sahası genişlemiş yetişkin hastalarda da giderek artan sayıda kullanılmaya başlanmıştır. Buna bağlı olarak pek çok soru ortaya çıkmaktadır; hangi hasta, ne zaman, nasıl, neden? Bu derlemede biz ECMO için hasta seçimi, endikasyonlar, kontrendikasyonlar, komplikasyonlar ve ECMO’nun teknik özellikleri ve sonuçlarına değinmeye çalıştık.

Keywords

• Ekstrakorporal membran oksijenizasyonu,solunum yetmezliği,kalp yetmezliği,hasta seçimi

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