Early awake ECMO may be used for patients
Posted: Sun Feb 02, 2025 8:44 am
If the patient is not suitable for long-term mechanical ventilation, i.e. the patient is unable to achieve expected results, ECMO replacement should be performed immediately. If any of the following conditions occur, ECMO replacement should be considered.
Decreased respiratory system compliance. After the alveolar opening maneuver, respiratory system compliance is < 10 ml/cm H2O;
Persistent exacerbation of pneumomediastinum or subcutaneous emphysema. And the parameters of artificial ventilation of the lungs, according to calculations, cannot be reduced within 48 hours;
PaO2/FiO2 <100 mmHg and the values cannot be improved by conventional methods within 72 hours.
1.3 Awake ECMO in the early stages
who have been maintained on mechanical ventilation with japan number data expected high parameters for more than 7 days and who meet the necessary conditions for awake ECMO. They may benefit from it. The following conditions must be met:
The patient is alert and fully compliant with the treatment regimen. He or she understands how ECMO works and the associated care requirements;
The patient does not have any neuromuscular diseases;
Murry's lung function index > 2.5;
Weak pulmonary secretion. The time interval between two airway suction procedures> 4 h;
Stable hemodynamics. No additional vascular drugs are required.
2 Methods of catheterization
Since the ECMO support time for most COVID-19 patients exceeds 7 days, the Seldinger technique should be used to insert the peripheral catheter under ultrasound guidance as much as possible, which reduces the bleeding and infection risk caused by intravascular catheterization by venous angiotomy, especially in patients who undergo awake ECMO in the early stages. Intravascular catheterization by venous angiotomy can only be considered for patients with severe blood vessel disease, or in patients in whom the catheterization cannot be identified and selected by ultrasound, or in patients in whom the Seldinger technique has failed.
Decreased respiratory system compliance. After the alveolar opening maneuver, respiratory system compliance is < 10 ml/cm H2O;
Persistent exacerbation of pneumomediastinum or subcutaneous emphysema. And the parameters of artificial ventilation of the lungs, according to calculations, cannot be reduced within 48 hours;
PaO2/FiO2 <100 mmHg and the values cannot be improved by conventional methods within 72 hours.
1.3 Awake ECMO in the early stages
who have been maintained on mechanical ventilation with japan number data expected high parameters for more than 7 days and who meet the necessary conditions for awake ECMO. They may benefit from it. The following conditions must be met:
The patient is alert and fully compliant with the treatment regimen. He or she understands how ECMO works and the associated care requirements;
The patient does not have any neuromuscular diseases;
Murry's lung function index > 2.5;
Weak pulmonary secretion. The time interval between two airway suction procedures> 4 h;
Stable hemodynamics. No additional vascular drugs are required.
2 Methods of catheterization
Since the ECMO support time for most COVID-19 patients exceeds 7 days, the Seldinger technique should be used to insert the peripheral catheter under ultrasound guidance as much as possible, which reduces the bleeding and infection risk caused by intravascular catheterization by venous angiotomy, especially in patients who undergo awake ECMO in the early stages. Intravascular catheterization by venous angiotomy can only be considered for patients with severe blood vessel disease, or in patients in whom the catheterization cannot be identified and selected by ultrasound, or in patients in whom the Seldinger technique has failed.