Extracorporeal Membrane Oxygenation

Year 2018, Volume: 21 Issue: 3, 236 - 244, 02.12.2018

Sadiye Deniz Özsoy Hülya Yılmaz Ak

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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