Title : ECMO past, present and future
The use of mechanical circulatory support has been increasing over the last 2 decades. The indications of extracorporeal life support (ECLS) are respiratory failure refractory to conventional management, post MI cardiogenic shock, post cardiotomy cardiogenic shock, ECMO CPR, PE, high risk PCI and sepsis. The improvement in oxygenators, pumps, cannulation techniques and anticoagulation strategy has decreased the incidence of complications. This talk we will mainly concentrate on veno-arterial(VA) ECMO. Indications for VA ECMO: Post MI cardiogenic shock with publication of the SHOCK 3 trial the recommendations and use of intraaortic balloon pump has been downgraded. ECLS has increasingly being used as a support therapy in this cohort of patient, with two trials presently recruiting. • ECPR The use of ECMO has been a recommended by the UK resuscitation council for refractory cardiac arrest. • There are increasing cases reports of PE, high risk PCI and severe sepsis being supported with ECLS. • We would look at different techniques of cannulation for VA ECLS. Maintenance of patient on ECLS and weaning of ECLS. The common complications of ECLS bleeding, harlequin syndrome, vascular damage and management of the complications. • We look to present systematic literature review on the evidence of ECLS and the recommendations. Critical appraisals on the new trials on ECLS, the new devices available and the new anticoagulation techniques that have led to improvement in outcomes of ECLS. • A crystal ball looks into the future development of ECLS and where newer modalities ECLS support are developing. The possible newer indications of ECLS and challenges faced. Audience Take Away: • Understanding when to refer to an ECMO centre • The indiations and contraindicarions of ECLS • The new frontiers in the world of ECLS.