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"Extracorporeal Membrane Oxygenation : An Interdisciplinary Problem-Based Learning Approach" provides an overview of the latest techniques, management strategies, and technology surrounding the clinical use of ECMO. ECMO is a miniaturized heart-lung-machine that can be used to support patients with either acute respiratory and/or cardiocirculatory failure in numerous scenarios and can be a bridge to either heart or lung transplantation. This book focuseson educating clinicians about this complex but life-saving technology.
Extracorporeal membrane oxygenation (ECMO) has been in clinical use for some 40 years, but it is only in the past decade that its application in the treatment of life-threatening circulatory and respiratory failure has truly flourished. This book presents a comprehensive overview of both pathophysiological and practical aspects of circulatory and respiratory extracorporeal support. The basics of ECMO, including its history, the “ECMO team”, cannulation, materials, and blood-surface interactions, are first discussed. The various indications for and particular characteristics of circulatory and respiratory extracorporeal life support are then described in detail in the main part of the book. Patient care during ECMO and monitoring of the ECMO patient are also carefully covered, with explanation of the management of technical and clinical complications and transport-related problems. Further topics include long-term therapy options beyond ECMO, such as ventricular assist devices and transplants, outcome, the new frontiers of ECMO for organ procurement and future challenges. The authors are well-known experts in the field whose authoritative contributions and attention to practical aspects will be invaluable for novices and experienced practitioners alike.
Extracorporeal membrane oxygenation (ECMO), despite a long and troubled history, is very rapidly evolving into a therapy that can be safely and effectively applied across the world in patients experiencing acute cardiac and/or pulmonary failure. As experiences grow, there is a better understanding of nuances of the importance of teamwork, therapy guidelines and protocols, patient selection, and understanding the functional aspects of pump-circuit technology as it interfaces with human biology. The challenges in managing these very sick and complex patients cannot be understated. The goal of this text is to provide a framework for the development and successful growth of a program. Authors from Centers of Excellence Worldwide have shared their experiences in the full spectrum in dealing with this evolving field.
This new edition presents an evidence-based review of extracorporeal membrane oxygenation (ECMO) for adults, with a particular focus on veno-venous (VV) ECMO. Due to the dramatic impact of COVID-19, the number of institutions offering ECMO, thus the number of clinicians performing ECMO (or referring their patients for ECMO), has exploded in a truly unprecedented way. While the pandemic may fade, programs built in response will survive by extending the application of ECMO to previously overlooked populations. This fully updated second edition refines its focus to VV ECMO, which has seen the most dramatic increase and relevance. This allows expert authors to go further in depth regarding VV ECMO and provide readers with better guidance from the physiology of VV ECMO to weaning and decannulation. Several areas have been expanded, including anti-thrombotic approaches; how to set the mechanical ventilator and judge the complex interactions between patient, ventilator, and ECMO circuit; assessing the systemic circulation during VV ECMO (especially right ventricular function and intravascular volume); and recognizing membrane lung dysfunction. Finally, new chapters addressing how the VV-capable clinician should think about VA ECMO and how to incorporate ethical principles in patient selection and withdrawal of ECMO have been added. This is an ideal guide for intensive care and respiratory medicine specialists, fellows training in critical care, ECMO specialist staff, perfusionists, nurses, and respiratory therapists.
Part of the Core Critical Care series, this book is an easy-to-read guide for the aspiring ECMO clinician. Doctors, nurses, physiotherapists, dieticians, pharmacists and all other key members of the team will learn the basics required to better understand the technology and care of the patient.
"Extra-corporeal membrane oxygenation (ECMO) is an innovative therapy that is used to support the physiologic needs of a patient during illnesses associated with acute severe respiratory and/or cardiac failure. ECMO is used in those life-threatening situations in which the oxygenation, ventilation, and circulatory support needs of the patient cannot be adequately maintained with a maximal conventional ventilator or pharmaceutical support. Essentially, ECMO is a simple pump circuit that can be used to support the role of failing lungs or hearts while therapies are aimed at organ recovery. While simple in concept and theory, this text illustrates the complexities associated with clinical use. The use of ECMO has evolved substantially overall the years-in part due to broader and growing applications, a better understanding of the technologies and how they can be used (especially in the context of long term human-ECMO circuit interactions), objective tools for patient selection, management protocols, and, most importantly, a growing body of evidence-based science and literature that demonstrates the effectiveness of this highly invasive, resource-intensive, and complex tool. The goal of this text is to draw from established thought leaders and experts around the world and present a comprehensive review of the rapidly-evolving and expanding literature regarding the spectrum of applications for ECMO. While by no means is this implied to be the final and exhaustive text on this topic, it does aim to be as comprehensive and up-to-date as possible which is, in itself, a challenge given how quickly this field is evolving. This text is aimed at students and providers, at all levels, who might have interest or be involved in the care of these critically ill patients. Chapters focus on how programs can be structured, the specific details of patient selection, management, and expanding roles of ECMO. Both basic and sophisticated concepts are presented with the goal that all may learn. We also present an objective assessment of some of the evolving challenges and limitations to ECMO in the context of the increased utilization and expansion of this therapy, combined with "sicker" patients, and the ongoing journey towards improved outcomes while offering a salvage therapy to patients who might otherwise die"--
Extracorporeal membrane oxygenation is an effective tool for managing patients with severe acute cardiogenic shock and/or respiratory failure. With emphasis on teamwork and adherence to guidelines, protocols, and objective tools to assist in patient selection, management, and weaning, outcomes have improved. Nevertheless, every aspect of supporting patients who require extracorporeal support remains a challenge - with many unanswered questions. The goal of this text, as a supplement to the previous editions on this rapidly evolving topic, is to provide the reader with a more in-depth review of some of the ongoing issues in this field. Topics ranging from administrative aspects to developing a program, nursing issues, ethical concerns, and a variety of clinical topics are discussed at length.
Mechanical Circulatory and Respiratory Support is a comprehensive overview of the past, present and future development of mechanical circulatory and respiratory support devices. Content from over 60 internationally-renowned experts focusses on the entire life-cycle of mechanical circulatory and respiratory support – from the descent into heart and lung failure, alternative medical management, device options, device design, implantation techniques, complications and medical management of the supported patient, patient-device interactions, cost effectiveness, route to market and a view to the future. This book is written as a useful resource for biomedical engineers and clinicians who are designing new mechanical circulatory or respiratory support devices, while also providing a comprehensive guide of the entire field for those who are already familiar with some areas and want to learn more. Reviews of the most cutting-edge research are provided throughout each chapter, along with guides on how to design new devices and which areas require specific focus for future research and development. Covers a variety of disciplines, from anatomy of organs and evolution of cardiovascular devices, to their clinical applications and the manufacturing and marketing of devices Provides engineering and clinical perspectives to assist readers in the design of a market appropriate device Discusses history, design, usage, and development of mechanical circulatory and respiratory support systems
Most patients with critical cardiac or thoracic conditions will at some stage pass through the cardiothoracic critical care unit. Critical care presents more complex clinical data than any other area of medicine. The new edition of Core Topics in Cardiothoracic Critical Care focuses on the latest practise in the management of patients in cardiothoracic intensive care. The practice of cardiothoracic critical care medicine is constantly evolving, and this new edition reflects the modernized learning styles for trainees. Each chapter includes key learning points as well as sample multiple choice questions and answers to assist in exam preparation. This edition also features updated chapters on ECMO, perioperative management of patients undergoing emergency cardiothoracic surgery, and advanced modes of organ support for patients. This text provides key knowledge in a concise and accessible manner for trainees, clinicians and consultants from specialities and disciplines such as cardiology and anaesthesia, and nursing and physiotherapy.