Bedekovich, Alison N, MSN, RN

Miller, Kenneth, MSRT, MEd, RRT-ACCS, FAARC,

Strow, Jennifer, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingThe Utilization of Venous-Venous ExtracorporealMembrane Oxygenation Membrane for theManagement of Status AsthmaticusKenneth Miller MSRT, MEd, RRT-ACCS, FAARC,Lehigh Valley Health Network, Kenneth.Miller@lvhn.orgJennifer Strow DOLehigh Valley Health Network, Jennifer_A.Strow@lvhn.orgAlison N. Bedekovich MSN, RNLehigh Valley Health Network, Alison_N.Bedekovich@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing Commons, and the Pulmonology CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtMiller, K. Strow, J. Bedekovich, A. (2018, December 6). The Utilization of Venous-Venous Extracorporeal Membrane OxygenationMembrane for the Management of Status Asthmaticus. Poster Presented at: International Conference of the American Association ofRespiratory care, Las Vegas Nevada.LVHN.org© 2018 Lehigh Valley Health NetworkINTRODUCTION LIFE THREATENING REFRACTORY ASTHMA:•  Requires intubation and mechanical ventilation•  Often presents with high level of arterial PaCO2 which require both a high minute ventilation and airway pressures despite lung protective ventilation and the administration of Heliox gas mixture•  Ventilator induced trauma (VILI) is common•  Has a mortality rate of around eight percentINTERVENTION•  Another approach to meet gas exchange goals and to provide maximum lung protective is to place these patients on venous-venous extracorporeal  membrane oxygenation  (ECMO) support.  •  The clinical rational for this management would be to protect  the lung from any additional VILI  and provide a stable level of ventilation and acid-base balance.•  Allows for other clinical interventions to be administered in a more systematic manner. The Utilization of Venous-Venous Extracorporeal Membrane Oxygenation Membrane for the Management of Status Asthmaticus Kenneth Miller, MSRT, MEd, RRT-ACCS, FAARC, Jennifer Strow, DO, Alison Bedekovich, MSN, RNLehigh Valley Health Network, Allentown, Pa.METHODS•  During a two year time frame, we placed six status asthmaticus patients with refractory gas exchange on V-V ECMO. •  Five of the six patients were managed on  V-V ECMO until the asthma exacerbation was stabilized and progressed to ECMO and ventilator liberation. •  One patient expired secondary to multi-system organ failure unrelated to asthma. •  All patients were ventilated via pressure or volume target modes to achieve an exhaled tidal volume between 4-5cc/kg/IBW and PEEP was set via either a pressure/volume tool or via transpulmonary monitoring. •  ECMO parameters were set to achieve a SpO2>88% and a PH>7.25. There was no additional occurrences of VILI post ECMO intervention. •  All patients receive pharmacological paralytics, heliox, and continuous beta-agonist therapy for the first forty hours of mechanical ventilation and ECMO support.Patient Number Age/G S/EVent Mode/SettingV-V ECMO LOSECMO SettingsExit time  from decannulationHeliox1 51/M S PCMV 4cc/kg 7 100/51pm 120 hrs. Y2 28/M S CMV 4cc/kg 8 100/91pm 70 hrs. Y3 49/M S PCMV 5cc/kg 5 100/4.51 pm 42 hrs. Y4 31/F E CMV 5cc/kg 15 80/31 pm NA Y5 18/M S CMV 4cc/kg 8 80/41 pm 209 hrs. Y6 31/F S PCMV  4cc/kg/IBW 9 100/1.51 pm 42 hrs. YAll received continuous Proventil nebulizationPEEP settings were guided by transpulmonary E-2 to 2cmPEEP range 10–16cmPatients 4 and 5 developed barotrauma prior to cannulationCONCLUSIONBASED ON OUR CLINICAL EXPERIENCES:•  V-V ECMO along with lung protective ventilation can provide a safe, clinical management of the status asthmaticus with refractory gas exchange. •  Lower minute ventilation and airway pressures can be achieved minimizing the risk of VILI.P/V toolECMO DeviceTranspulmonary Monitoring Heliox Administration

The Utilization of Venous-Venous Extracorporeal Membrane Oxygenation Membrane for the Management of Status Asthmaticus

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The Utilization of Venous-Venous Extracorporeal Membrane Oxygenation Membrane for the Management of Status Asthmaticus

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