Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
So currently we’re working with a client who is on VA ECMO, balloon pump, and is also in lung failure and the client is asking what needs to happen to remove VA ECMO. And then they’re asking what needs to happen to remove VV ECMO for lung failure. So the plan for the client is to be removed from VA ECMO for heart failure after a heart attack. And then the next step is the client will go back on VV ECMO, which is for lung failure. And then they’re asking what needs to happen for both ECMOs to be removed.
So let’s dive right into this very quickly. So for VA ECMO for heart failure to be removed, what needs to happen is, the cardiac output needs to be sufficient and cardiac index needs to be sufficient. Cardiac output needing to be around 7 mls per kilo for a 90-kilo man that needs to be around 7 liters per minute.
So that’s what needs to happen to remove VA ECMO, but also they need a little bit of inotropic support, such as milrinone and dobutamine. The balloon pump needs to be removed as well. Maybe they need a little bit of noradrenaline to maintain blood pressure, especially the mean arterial blood pressure needs to be above 65 as well.
And obviously, the weaning studies for VA ECMO need to be complete. They need to show a good ejection fraction after a cardiac echo or ultrasound. The ejection fraction should be around 35% or higher. So that’s what needs to happen for VA ECMO to be removed. And obviously, ideally, a patient is in sinus rhythm or a regular heart rhythm as well. And obviously, arterial blood gases need to be sufficient, with PO2 above 70, also PCO2 within a physiological range, and pH should be within a normal range as well.
So then this particular client has gone on to VV ECMO for lung failure after VA ECMO has been removed and the client is asking again, what needs to happen for VV ECMO to be removed? Well, number one is the arterial blood gases, again, need to be sufficient. Oxygen levels need to be reduced on the ECMO. Arterial blood gases (ABG), again, need to be within physiological levels, ventilator oxygen FIO2 levels need to be less than 60% ideally. Chest x-ray needs to show improvement. And maybe they need a little bit of support, especially if they are in ARDS such as steroids or also epoprostenol or sildenafil, especially if they have pulmonary hypertension, which they often do.
So that is my quick tip for today.
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This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.