ECMO Insertion (체외심폐막)

​ECMO Insertion - VA ECMO axillary  

central V-A ECMO insertion Axillofemoral

 

 

 

 

<op procedure>

 

1.Right subclavian incision, exposure of previous graft stump

15mess incision -> bovie approach -> mastoid ret apply -> self ret 

Axillary artery 확인 후 utape sling 

 

2.Heparin injection, santisky clamp (angio set 內)

 

3.8mm dacron graft was anastomosed to stump

8mm graft - 7/0 prolene double (pledget x)

suture 확인 하기 위해 sharp hook으로 확인

graft로 blood flow 확인 후 ㄱ자 clamp

 

4.placement of connector betwenen graft and A-Line

tubal clamp

 

5.Insertion of V-cannula into Left CFV, Completion of V-A ECMO 

tubal clamp 

 

6.Subclavian wound closure, dressing

2/0(3/0) safil ->2/0(3/0) nylon

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

<ECMO Type>

1. veno-arterial ECMO (VA-ECMO): allows gas exchange and haemodynamic support while blood is pumped from the venous to the arterial side;

2. veno-venous (VV-ECMO): facilitates gas exchange; blood is removed from the venous side and then pumped back into it, but does not provide haemodynamic support;

3. arterio-venous ECMO (AV-ECMO): facilitates gas exchange by using the patient's own arterial pressure to pump the blood from the arterial to the venous side.

 

 

 

 

 

 

 

 

Femoral-femoral bypass is instituted by placing an arterial cannula in the common femoral artery

and a venous return cannula in the common femoral vein.

 

For patients with small or diseased arteries, construction of a “side arm” with a prosthetic graft ensures

distal perfusion of the leg. When using this strategy in acute aortic dissection,

 

the surgeon should select the artery with the strongest pulse.

 

High arterial pressure in the return cannula is strongly suggestive of impaired perfusion,

and the cannula should be removed and placed in the opposite common femoral artery.

 

                                                                                                  

Antegrade perfusion via the right axillary artery is useful for operations on the aortic arch.

It can be used as the sole method for arterial return during cardiopulmonary bypass, or

it can be used to provide partial, selective antegrade cerebral perfusion during periods of hypothermic circulatory arrest.

An oblique incision is made 1 cm below the right clavicle for exposure of the axillary artery.

                                                                                                  

                                                                                                                                                                              

The pectoralis major muscle is separated in the direction of its fibers to enter the subclavicular space.

The artery is isolated with vascular loops, taking care to avoid injury to the brachial plexus.

 

                                                                                                                                                                              

A longitudinal incision is made in the artery.

An 8 mm prosthetic graft is beveled and attached in an end-to-side fashion

using continuous stiches of 5/0 polypropylene suture.

                                                                                                  

                                                                                                  

The graft is trimmed to about 20 cm in length, and a 22 F arterial return cannula is inserted into the graft.

The cannula is secured with multiple ties around the graft and connected to the cardiopulmonary bypass circuit.

Antegrade perfusion is delivered through the axillary graft to the right arm and the aortic arch.

During periods of circulatory arrest, the innominate artery is clamped,

and selective antegrade perfusion of the brain can be performed through the right common carotid artery.

 

 

 

 

<참고 출처>

http://www.medscape.com/

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