This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.

1. MECHANICAL VENTILATION
AND LOW FLOW ECCO2R
Jonckheer Joop

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INTRODUCTION
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Goals of mechanical “ventilation”
Ventilation:
CO2
MV = TV x f
Oxygenation
O2
PEEP & FiO2
I/E

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INTRODUCTION
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Mechanical power & Toxicity O2
Atelectotrauma
Volumotrauma
Barotrauma
CO2
O2

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MECHANICAL VENTILATION
Pplat < 30
TV 6ml/kg
VS
Pplat <50
TV 12 ml/kg
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Barotrauma & Volumotrauma

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MECHANICAL VENTILATION
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Respiratory rate ???

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MECHANICAL VENTILATION
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Volumotrauma

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MECHANICAL VENTILATION
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oxygenation

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MECHANICAL VENTILATION
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oxygenation

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VOLUME VS PRESSURE CONTROL VENTILATION?
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Volume Pressure

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VOLUME VS PRESSURE CONTROL VENTILATION?
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Volume Pressure

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PRONING
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MECHANICAL VENTILATION
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Conclusion on limits
Δ P< 15
TV 0.6 ml/kg
Pplat< 30 cmH2O
RR ???
FiO2 < 60%
PEEP ↑
CO2

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ECCO2R SYSTEMS
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N=
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N=95
SAE: 6
ECCO2R-SAE: 2
ECCO2R-AE: 39%
AIM:

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INDICATION ECCO2R
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Case series and case reports…
Further evidence is needed

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ECCO2R SYSTEMS
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ECCO2R
Does it really give less complications than vv-ECMO ???
Pro:
- Smaller cannulas ? => smaller holes
- Low flow => lesser “tear” trauma on RBC ? ( theoretical)
Con:
- Smaller cannulas => lower flow? More thrombosis
- Low flow => needs anticoagulation.
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flow

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CITRATE ANTICOAGULATION
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41 32
CO2 in effluent
( ml/min)
24 ± 5 38 ± 12 23 ± 5 NA
True REE (Kcal /day) 1935 ± 921 1723 ± 752 1604 ± 633 1713 ± 704
* 0,65
* 0,014
* 0,193
+
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ANALOGY EVOLUTION CRRT
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Veno-venous

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CO2 REMOVAL ?
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25. THANK YOU
Tel: 0032498638164
E-mail: Joop.jonckheer@uzbrussel.be
@joopjonckheer
www.ricula.be

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PRESSURE RELEASE VENTILATION VS
PRESSURE ASSISTED VENTILATION DURING ARDS
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