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ECMO can either provide total cardiopulmonary support (veno-arterial or VA-ECMO) or pulmonary support (veno-venous or VV-ECMO). The technique effectively enables the use of CPB in an ICU setting. In adult practice, ECMO was initially reserved for patients with severe respiratory failure secondary to ARDS. ECMO in adults fell out of favour, largely because of poor outcomes. In paediatric practice, where outcomes are generally better, ECMO has remained in routine use for over three decades. Recent H1N1 (‘swine flu’) epidemics have led to a re-examination of the role of ECMO in adults with respiratory failure and a re-emergence of VV-ECMO.
This chapter describes the procedure for setting up the cardiopulmonary bypass (CPB) system and the safety checks that should be undertaken before embarking on a case. Preparing the CPB circuit and machine, attention to the patient's clinical details and the surgical requirements for the procedure all form part of the process of safe provision of CPB. Most operating rooms have an uninterruptible power supply (UPS), essentially a series of batteries linked to the hospital generator that powers the CPB machine, anesthetic machine, intravenous infusion pumps and other vital equipment should there be a mains power failure. The bubble detector is coupled to the CPB machine console so that if air is sensed in the arterial line an alarmed automatic pump cut out facility is activated. The format of the CPB checklist is either written or automated and best signed off by two perfusionists.