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The ECMO Book
- 1st Edition - March 23, 2023
- Author: Jeffrey DellaVolpe
- Language: English
- Paperback ISBN:9 7 8 - 0 - 4 4 3 - 1 1 1 9 8 - 3
- eBook ISBN:9 7 8 - 0 - 4 4 3 - 1 1 2 7 4 - 4
ECMO (extracorporeal membrane oxygenation) is a crucial form of support for patients with respiratory failure, severe ARDS, COVID-19, and cardiogenic shock whose use has been… Read more
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Institutional subscription on ScienceDirect
Request a sales quoteECMO (extracorporeal membrane oxygenation) is a crucial form of support for patients with respiratory failure, severe ARDS, COVID-19, and cardiogenic shock whose use has been increasing exponentially around the world. The ECMO Book offers a comprehensive yet approachable framework for understanding the principles of extracorporeal support as well as the subtleties related to the care of patients needing ECMO. Dr. Jeffrey DellaVolpe provides authoritative, consistent guidance on all aspects of ECMO, making complex information understandable and accessible and helping you increase your knowledge of and proficiency with this multifaceted therapy.
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Establishes the context of ECMO in the care of critically ill patients (patient selection, indications, contraindications), progressing from basic science information through advanced ECMO concepts.
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Explores physiologic fundamentals and builds on these concepts by applying them to extracorporeal support, equipping you with a sound framework for how those principles can be applied in the day-to-day management of patients with severe cardiac and respiratory failure.
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Covers key topics such as blood flow titration, sweep gas titration, ventilator management on ECMO, and anticoagulation and bleeding management.
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An eBook version is included with purchase. The eBook allows you to access all of the text, figures and references, with the ability to search, customize your content, make notes and highlights, and have content read aloud.
Critical care physicians, physicians taking care of patients on ECMO (CT surgeons, anesthesiologists, cardiologists, intensivists, etc.
- Cover image
- Title page
- Table of Contents
- Any screen, Any time, Anywhere
- Copyright
- Dedication
- Acknowledgments
- Preface
- What this material is about
- How we will do this
- What this material is designed to do
- What this book is not designed to do
- Part I: Physiology
- 1. Oxygen Delivery and Consumption
- How is oxygen delivered in the body?
- What allows for efficient delivery of oxygen throughout the body?
- How does hemoglobin allow for more efficient oxygen delivery?
- What is the significance of all of this when it comes to delivery of oxygen?
- How is PaO2 different from SaO2?
- The role of oxygen consumption
- Suggested reading
- 2Chapter 2. Shock
- What is shock?
- What is the difference between low blood pressure and shock?
- What is the relationship of MAP to cardiac output?
- Reframing how we define shock
- How do we classify shock?
- Uncovering the true etiology of shock
- Optimizing cardiac output in shock
- How does excess preload adversely affect cardiac output in a failing right ventricle?
- How can we use this model of shock to improve the management of our patients?
- Putting it together
- SUGGESTED READING
- 3. Recognition of Shock
- What does shock look like at the bedside?
- Putting it all together
- Suggested reading
- 4. Hypoxia
- How does oxygen enter the body?
- When the system breaks down
- What does hypoxia due to shunt look like?
- Impact of positive pressure on hypoxia due to shunt
- What is the mean airway pressure and how can we augment it?
- What are the effects of increasing PEEP?
- What are the effects of worsening compliance?
- The challenging tradeoff of worsening respiratory failure
- Putting it together
- Suggested reading
- 5. The Failure of DO2 – Did What I Do to the Patient Just Work?
- What is meant by dose-related toxicity of ICU interventions?
- Is this really a fair example?
- What is happening with this patient?
- How do pressors worsen the clinical situation in shock?
- How do I prevent the downward spiral of shock?
- Why is increasing the amount of oxygen harmful?
- Harmful effects of raising mean airway pressure
- What about hemoglobin?
- The final point…
- Suggested reading
- Part II: ECMO Fundamentals
- 6. Introduction to ECMO Fundamentals
- So what is ECMO?
- Why does the ECMO circuit seem more complicated when I look at it?
- Understanding the oxygenator: the fundamental mechanism of ECMO
- Where does the blood go from here?
- How can I manipulate the circuit?
- Putting it all together
- Suggested Reading
- 7. Indications and Selection of Patients for ECMO
- So how can we get better at finding this select group of patients?
- Putting it all together
- Suggested reading
- 8. ECMO Configurations
- Cannula selection
- Naming convention
- Femoral jugular VV ECMO
- Femoral-femoral VV ECMO
- Additional venous drain
- Dual lumen cannula
- Femoral-PA VV ECMO
- VA ECMO: femoral-femoral
- Arterial access for VA ECMO
- VA ECMO: surgical cannulation
- IJ axillary cannulation
- Central cannulation: femoral aortic
- Hybrid configurations: where VA and VV meet
- A final word
- Suggested reading
- 9. Components, Sensors, and Circuit Access
- Tubing
- Pump
- Mechanical backup
- Console
- Sensors: measuring ECMO support
- Circuit access points
- The circuit check: the most important part of your day
- Suggested reading
- Part III: ECMO Physiology
- 10. Blood Flow Dynamics
- Why is blood flow so essential in ECMO support?
- What about FiO2?
- What are the determinants of blood flow on ECMO support?
- Limits of the membrane oxygenator
- Effect of membrane limits: The rated flow of the membrane
- Blood flow limits of the circuit
- Pressure differential: Role of centrifugal pump
- The effect of resistance and the limitation of flow
- Putting it all together
- Suggested reading
- 11. Membrane Characteristics
- What is the basic function of the membrane oxygenator?
- Is ECMO more efficient at oxygenation or CO2 clearance?
- Leveraging sweep gas flow rate
- Limitations of the membrane oxygenator
- Evaluation of oxygenator function
- Evaluation of CO2 clearance
- Evaluation of oxygenation
- Evaluation of membrane function: Damage to blood cells/consumption
- Evaluation of membrane function: Effect on membrane blood flow and pressure
- Failure of membrane function due to recirculation
- Putting it together
- Suggested reading
- 12. Veno-Venous ECMO Physiology
- VV ECMO: the basics
- Mechanism of hemodynamic/respiratory benefits of VV ECMO
- Effect of VV ECMO on shunt physiology
- Hemodynamic effects of VV ECMO
- Other variables contributing to oxygenation in VV ECMO
- Limitations to the cardiac/hemodynamic effects of VV ECMO
- Putting it together: the risk-benefit of VV ECMO support
- Suggested reading
- 13. Veno-Arterial ECMO Physiology
- Vicious cycle of cardiogenic shock
- Rationale of VA ECMO in cardiogenic shock: Effect on the viciouscycle
- Putting it together: VA ECMO and the vicious cycle of cardiogenicshock
- Suggested reading
- 14. Physiology of Retrograde Flow
- The directional flow of the vascular system
- The necessity of retrograde flow
- Left ventricular afterload sensitivity
- Which way is blood flowing again?
- Worsening hypoxia while on VA ECMO: Identification and mitigation
- Titration of support on VAV ECMO
- How do you know how blood is being divided?
- Putting it all together
- Suggested reading
- 15. Central Veno-Arterial ECMO Physiology
- Primary central cannulation configuration
- Antegrade flow and perfusion of coronary arteries
- Limits to blood flow on central cannulation
- Left ventricular venting in central cannulation
- Regulation of blood flow on central VA ECMO
- Regulation of sweep gas flow on central VA ECMO
- Effect of native cardiac output on antegrade central flow
- Hypoxia on central VA ECMO?
- Putting it together: the risks/benefits of central ECMO
- Suggested reading
- Part IV: ECMO Management
- 16. Introduction to ECMO Management Principles
- The cornerstone of ECMO management: Lessen toxicity
- Does ECMO fix all these complications?
- Putting it together
- Suggested Reading
- 17. Blood Flow Titration
- The ins and outs of flow titration
- How much flow is enough? How much is too much?
- Separating out preload from afterload limitations of the pump/circuit
- Weaning ECMO blood flow
- Suggested reading
- 18. Sweep Gas Flow Titration
- Basics of sweep gas flow titration
- Placing sweep gas flow into the clinical phase of ECMO support
- Impact of sweep gas flow on CO2 buffering
- Sweep gas titration at the bedside
- Sweep gas titration in VA ECMO
- Weaning in VA ECMO
- Weaning in VV ECMO
- Weaning FiO2 to sweep gas flow
- Putting it together
- Suggested reading
- 19. Ventilator Management on ECMO
- Common ventilator settings in ECMO support
- Mode of ventilation: Spontaneous versus controlled ventilation
- Positive end-expiratory pressure targets during ECMO
- Limiting FiO2 from the ventilator
- A note on hypoxia on ECMO
- Controlling the respiratory rate
- Extubation on ECMO: Why use the ventilator at all?
- Putting it together
- Suggested Reading
- 20. Anticoagulation and Bleeding Management
- Why do we need to anticoagulate in ECMO?
- Understanding the principles behind hemostasis
- The coagulation cascade: How clotting is regulated
- Anticoagulation and ECMO
- Heparin use in ECMO
- Measuring the effect of heparin
- Challenges in the use of heparin on ECMO
- Direct thrombin inhibitors: a potential alternate for anticoagulation?
- Other options for thrombosis inhibition in ECMO
- Bleeding prevention, mitigation, and management
- Improving clot strength while on anticoagulation
- Putting it together
- Suggested reading
- 21. Pharmacokinetics
- Normal effect of a drug on the body
- Variations in pharmacokinetics: Effects of critical illness
- Changes to pharmacokinetics during ECMO
- ECMO and sedation: the effects of protein binding
- Pharmacokinetics of antibiotics on ECMO
- Putting it together
- Suggested Reading
- Epilogue: Bringing mastery to the bedside
- Index
- Confidence is ClinicalKey
- No. of pages: 248
- Language: English
- Edition: 1
- Published: March 23, 2023
- Imprint: Elsevier
- Paperback ISBN: 9780443111983
- eBook ISBN: 9780443112744
JD
Jeffrey DellaVolpe
Dr. Dellavolpe serves as the Medical Director of the Adult ECMO Program at Methodist Hospital, San Antonio, Texas. He is also the Medical Director of the Cardiovascular Intensive Care Unit at Methodist Healthcare System and the Texas IPS Critical Care Service Line. He serves as chair of the Joint Society of Critical Care Medicine/Extracorporeal Life Support Organization Task Force.
Affiliations and expertise
Texas, IPS Medical Center, Pulmonary/Sleep Clinic, San Antonio, Texas