介绍台大医院

ECMO Introduction 台大醫院 外科加護病房 柯文哲 醫師 ECMO Introduction Dr. Wen-Je Ko SICU, Department of Surgery National Taiwan University Hospital ECMO extracorporeal membrane oxygenation (體外膜氧合器) (艾克膜) (體外維生系統) ECMO extracorporeal membrane oxygenation (Extracorporeal Life Support) ECMO prolonged partial cardiopulmonary bypass ECMO vs CPB Veneous reservoir CPB vs ECMO ECMO Short-term cardiopulmonary support Buy time to decide the next step Recovery Transplantation long-term device (ventricular assist device) Operation (CABG, pulmonary embolectomy,) Give-up for lung 1. support : O2 supply & CO2 removal 2. rest : reduce ventilator induced lung injury for heart support : improve systemic perfusion rest : catecholamine myocardial work decrease preload requirement and congestion ECMO Type VV - ECMO VA - ECMO VV-ECMO indication : for lung disease only purpose : to decrease barotrauma ( to prevent ventilator-induced lung injury) ventilator setting : PC mode, PEEP 10 , PIP PaCO2, FiO2 PaO2 VA-ECMO advantage : 1. both lung & heart support 2. higher PaO2 An Example of MCS ECMOVAD HTx Different patients Different situations Different treatments Indications of ECMO in the near future As a mechanical circulatory support: Post-cardiotomy cardiogenic shock Double bridge (ECMO VAD HTx) Acute myocarditis AMI cardiogenic shock (ECPR) Replace CPB: Lung transplantation Neurosurgery Non-heart-beating-donor support Rescue for acu