I would like information on the use of extracorporeal membrane oxygenation for the adult as well as comparison with hyperbaric in extrememly anemic patients who refuse transfusion.

Hi Johnean,

I found the following for you, but am pasting the Risk section first as it discusses risk of frequent blood transfusions:

From - http://www.healthatoz.com/healthatoz...xygenation.jsp

Risks

Bleeding is the biggest risk for ECMO patients, since blood thinners are given to guard against blood clots. Bleeding can occur anywhere in the body, but is most serious when it occurs in the brain. This is why doctors periodically perform ultrasound brain scans of anyone on ECMO. Stroke, which may be caused by bleeding or blood clots in the brain, has occurred in some patients undergoing ECMO.

If bleeding becomes a problem, the patient may require frequent blood transfusions or operations to control the bleeding. If the bleeding can't be stopped, ECMO will be withdrawn.


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ECMO is also used to support a child or adult patient's damaged, infected, or failing lungs for a few hours to allow treatment or healing. It is effective for those patients with severe, but reversible, heart or lung problems who haven't responded to treatment with a ventilator, drugs, or extra oxygen. Adults and children who need ECMO usually have one of these problems:

• heart failure
• pneumonia
• respiratory failure caused by trauma or severe infection

The ECMO procedure can help a patient's lungs and heart rest and recover, but it will not cure the underlying disease. Any patient who requires ECMO is seriously ill and will likely die without the treatment. Because there is some risk involved, this method is used only when other means of support have failed.

Precautions

Typically, ECMO patients have daily chest x rays and blood work, and constant vital sign monitoring. They are usually placed on a special rotating bed that is designed to decrease pressure on the skin and help move secretions from the lungs.

After the patient is stable on ECMO, the breathing machine settings will be lowered to "rest" settings, which allows the lungs to rest without the risk of too much oxygen or pressure from the ventilator.

Description

There are two types of ECMO: Venoarterial (V-A) ECMO supports the heart and lungs, and is used for patients with blood pressure or heart functioning problems in addition to respiratory problems. Venovenous (V-V) ECMO supports the lungs only.

V-A ECMO requires the insertion of two tubes, one in the jugular and one in the carotid artery. In the V-V ECMO procedure, the surgeon places a plastic tube into the jugular vein through a small incision in the neck.

Once in place, the tubes are connected to the ECMO circuit, and then the machine is turned on. The patient's blood flows out through the tube and may look very dark because it contains very little oxygen. A pump pushes the blood through an artificial membrane lung, where oxygen is added and carbon dioxide is removed. The size of the artificial lung depends on the size of the patient; sometimes adults need two lungs. The blood is then warmed and returned to the patient. A steady amount of blood (called the flow rate) is pushed through the ECMO machine every minute. As the patient improves, the flow rate is lowered.

Many patients require heavy sedation while they are on ECMO to lessen the amount of oxygen needed by the muscles.

As the patient improves, the amount of ECMO support will be decreased gradually, until the machine is turned off for a brief trial period. If the patient does well without ECMO, the treatment is stopped.

Typically, newborns remain on ECMO for three to seven days, although some babies need more time (especially if they have a diaphragmatic hernia). Once the baby is off ECMO, he or she will still need a ventilator (breathing machine) for a few days or weeks. Adults may remain on ECMO for days to weeks, depending on the condition of the patient, but treatment may be continued for a longer time depending on the type of heart or lung disease, the amount of damage to the lungs before ECMO was begun, and the presence of any other illnesses or health problems.

Preparation

Before ECMO is begun, the patient receives medication to ease pain and restrict movement.

Aftercare

Because infants on ECMO may have been struggling with low oxygen levels before treatment, they may be at higher risk for developmental problems. They will need to be monitored as they grow.

Risks

Bleeding is the biggest risk for ECMO patients, since blood thinners are given to guard against blood clots. Bleeding can occur anywhere in the body, but is most serious when it occurs in the brain. This is why doctors periodically perform ultrasound brain scans of anyone on ECMO. Stroke, which may be caused by bleeding or blood clots in the brain, has occurred in some patients undergoing ECMO.

If bleeding becomes a problem, the patient may require frequent blood transfusions or operations to control the bleeding. If the bleeding can't be stopped, ECMO will be withdrawn.

Other risks include infection or vocal cord injury. Some patients develop severe blood infections that cause irreversible damage to vital organs.

There is a small chance that some part of the complex equipment may fail, which could introduce air into the system or affect the patient's blood levels, causing damage or death of vital organs (including the brain). For this reason, the ECMO circuit is constantly monitored by a trained technologist.

__________________
Mr. Jan B. Wade
Blood Management Consultant
Enhance Outcomes - Control Cost
For Information Call - 360 296-1807
Email

This is the low down on the two. ECMO is long term CPB and is EXTREMELY invasive and many things can and ussualy do go wrong with a high chance of M&M and is only reserved for those patients with no other choices left.
A Hyperbaric chamber is like an uncomfortably small hotel room that you have been grounded to, and you can't leave for a certain amount of time. It's not invasive other than the multiple number of atmospheres that you are exposed to force natural gases to do their work. I hope this helps.

__________________
Keith A. Samolyk CCP, LCP
Global Blood Resources LLC
P.O. Box 383 Somers CT. 06071
Tel (800) - 942 - 9243
Fax (860) - 285 - 0289
www.mybloodfirst.com

How effective is hyperbaric oxygen therapy when the patient is treated in the ICU
with positive intermittent pressure ventilation and general supportive measures with pulsed oxygen therapy with the purpose of oxygenating blood plasma rather the hemoglobin?