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Chapter 23Chapter 23

Extracorporeal Life SupportExtracorporeal Life Support

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Extracorporeal SupportExtracorporeal Support

The technique of supporting the function of The technique of supporting the function of the heart or lungs, or both, with external the heart or lungs, or both, with external artificial organsartificial organs

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HistoryHistory

GibbonGibbon 1937 animals1937 animals 1953 humans1953 humans

Lillehei 1955Lillehei 1955 Clowes 1956Clowes 1956 Doren 1969Doren 1969 Barlett & Harken 1975Barlett & Harken 1975

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Neonatal TreatmentNeonatal Treatment

Persistent pulmonary hypertension of the Persistent pulmonary hypertension of the newbornnewborn

Meconium aspiration syndromeMeconium aspiration syndrome SepsisSepsis Congenital diaphragmatic herniaCongenital diaphragmatic hernia

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Patient SelectionPatient Selection

Oxygen indexOxygen index Intraventricular hemorrhageIntraventricular hemorrhage Gestation ageGestation age CoagulopathyCoagulopathy Pulmonary diseasePulmonary disease Cardiac defectsCardiac defects

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Pediatric TreatmentPediatric Treatment

ResearchResearch European ECLS experienceEuropean ECLS experience O’RourkeO’Rourke WeberWeber SwanikerSwaniker

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Venoarterial RouteVenoarterial Route

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Venovenous RouteVenovenous Route

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ECLS CircuitECLS Circuit

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Membrane OxygenatorMembrane Oxygenator

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CannulationCannulation

ConsentConsent Blood productsBlood products

Patient positioningPatient positioning Monitor patient and prepare equipmentMonitor patient and prepare equipment Cannula insertion techniqueCannula insertion technique Connect patient to circuitConnect patient to circuit

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Management and MonitoringManagement and Monitoring

CardiovascularCardiovascular AnticoagulationAnticoagulation HematologicHematologic NeurologicNeurologic PulmonaryPulmonary Fluid balanceFluid balance

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WeaningWeaning

VenoarterialVenoarterial Improved lung functionImproved lung function

• Decrease ECLS support; increase ventilator supportDecrease ECLS support; increase ventilator support• Intermittent clamp ECLS supportIntermittent clamp ECLS support

VenovenousVenovenous Increase ventilator supportIncrease ventilator support Isolate gas ports from ambient airIsolate gas ports from ambient air

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DecannulationDecannulation

Sedative and paralyticSedative and paralytic Infusions to peripheral IVsInfusions to peripheral IVs DC heparinDC heparin Mirror image of cannulation processMirror image of cannulation process

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ComplicationsComplications

PatientPatient NeurologicNeurologic Cardiac stunCardiac stun

TechnicalTechnical