Extracorporeal Membrane Oxygenation (ECMO) System

Gwaro rakazara reruzivo rweECMO rwekutsigira hupenyu paApollo Hospitals

tsananguro

Extracorporeal Membrane Oxygenation (ECMO) itekinoroji inotsigira hupenyu inopa rutsigiro rwemwoyo nekufema kwenguva refu kuvarwere vane mwoyo nemapapu asingakwanise kushanda zvakanaka. Iyi nzira yekurapa yepamusoro inoshandiswa munzvimbo dzevarwere vane chirwere chepfungwa, kunyanya maICU, kune varwere vane chirwere chekufema chakanyanya kana chemwoyo. Sisitimu yeECMO inoonekwa seyakanaka nekuda kwekugona kwayo kuisa mweya muropa kunze kwemuviri, zvichibvumira moyo nemapapu nguva yekupora kana kupora.

Sisitimu yeECMO ine pombi inotenderera ropa kuburikidza nemapapu ekugadzira (membrane oxygenator) uko kabhoni dioxide inobviswa uye okisijeni inowedzerwa ropa risati radzorerwa kumurwere. Maitiro aya anotevedzera mashandiro echisikigo emwoyo nemapapu, zvichipa rutsigiro rwakakosha panguva dzemamiriro ezvinhu anotyisidzira hupenyu.

Mhando yeMaitiro

ECMO inzira yekubatsira vanhu vakawanda, inoshandisa simba rekushandisa simba rehupenyu, inoshandiswa mumakamuri evarwere vane chirwere chekufema chakanyanya, chinogona kugadziriswa kana kutadza kwemoyo, uye isingapindure kurapwa kwakajairika. Haisi nzira yemazuva ese uye haina kufanana nekurapa kusingapindi zvakanyanya kana kuti kusingapindi zvakanyanya.

ECMO inosanganisira:

• Kubviswa kwetsinga dzeropa dzakakura: Kuisa macannula makuru mutsinga huru dzeropa, zvichiwanzoda kuchekwa kwetsinga dzemutsipa, dzepahuro, kana dzepachipfuva. Saizi uye nzvimbo yemacannula aya zvine njodzi huru pakuita basa racho.
• Kurwisa ropa kunokonzerwa neropa uchishandisa heparin: Izvi zvinodiwa kudzivirira kugwinha kweropa muchikamu chekunze kwemuviri. Kudzivirira kugwinha kweropa uku kunowedzera njodzi yekubuda ropa mumuviri wese.
• Kuongororwa nguva dzose kweICU: ECMO inoda kutariswa nechikwata cheECMO chine hunyanzvi, kusanganisira vanachiremba vanoongorora ropa, vanachiremba vemwoyo, uye vanamukoti vanorwara zvakanyanya. Varwere vari paECMO vanoda kutariswa nguva dzese pamubhedha.
• Njodzi dzakakura: Izvi zvinosanganisira kubuda ropa zvakanyanya, thrombosis, ischemia yemitezo, sitiroko, hutachiona, kubuda ropa, kutadza kushanda zvakanaka kweitsvo, uye matambudziko emagetsi akadai sekutadza kushanda zvakanaka kweoxygenator kana kuputika kwechubhu.

ECMO inotangwa nevanhu vanoongorora murwere zvakanyanya uye mapoka akadzidziswa neECMO senzira yekukurumidzira kana yekukurumidzira. Haisi nzira inorongwa nevarwere kana mhuri. Sarudzo yekuisa murwere paECMO inotorwa nechikwata chekurapa chinoenderana nekuoma kwemamiriro ekurapa uye mukana wekupora.

chinangwa

Chinangwa chikuru cheECMO system ndechekupa rutsigiro rwechinguvana kana moyo, mapapu, kana zvese zviri kutadza kushanda uye zvisingapindure kurapwa kwakajairika. ECMO inobvumira nhengo idzi kuzorora nekupora panguva iyo chirwere chiripo chichirapwa.

Sisitimu iyi inoshandiswa mune zvinotevera mamiriro ekiriniki:

• Kukundikana kukuru kwekufema: Kusanganisira chirwere chekufema chinokonzeresa kufema (ARDS), pneumonia yakanyanya, uye kutadza kufema kunokonzerwa neCOVID-19 kana zvimwe zvirwere, kana mhepo yekufema isina kukwana.
• Kukundikana kwemwoyo: Kusanganisira cardiogenic shock, refractory cardiac arrest, uye kutadza kusiya cardiopulmonary bypass mushure mekuvhiyiwa kwemwoyo.
• Bhiriji rekuisa mbeu muchimiro chemuti: ECMO inogona kutsigira varwere pavanenge vakamirira kuisirwa moyo kana mapapu.
• Bhiriji rekupora: Kupa nguva yekuti mwoyo kana mapapu apore kubva mukukuvara kwakanyanya kana kurwara.
• Bhiriji rekusarudza: Kuchengetedza kuyerera kweropa munhengo uku chikwata chevanachiremba chichiongorora kana paine dzimwe nzira dzekurapa dziripo.

Ainoita

Sisitimu yeECMO inoshanda nekuburitsa ropa kubva kumurwere kuburikidza ne cannula hombe, ichipfuudza nepa membrane oxygenator uko okisijeni inowedzerwa uye carbon dioxide inobviswa, ichidziisa ropa kusvika patembiricha yemuviri, uye yozoridzosera kumurwere kuburikidza neimwe cannula. Pombi inofambisa ropa kuburikidza necircuit.

Pane maviri makuru magadzirirwo:

Veno-Venous (VV) ECMO

MuVV-ECMO, ropa rinotorwa kubva mutsinga dzodzorerwa kuropa. Kurongeka uku kunopa rutsigiro rwekufema chete, kusanganisira oxygenation uye kubviswa kwecarbon dioxide. Kunoshandiswa kana mapapu achikundikana asi moyo uchishanda zvakanaka. Mwoyo wemurwere unoramba uchipomba ropa mumuviri.

Veno-Arterial (VA) ECMO

MuVA-ECMO, ropa rinotorwa kubva mutsinga dzeropa rodzoserwa kutsinga dzeropa. Kurongeka uku kunopa rutsigiro rwemwoyo nekufema. Kunoshandiswa kana mwoyo nemapapu zvichikundikana, kana kana moyo wega uchikundikana, senge mukuvhunduka kwemoyo kana kumisa kwemoyo.

Zvikamu zvakakosha zvedunhu reECMO zvinosanganisira:

• Cannulas: Machubhu makuru anoiswa mutsinga huru dzeropa kuti abudise ropa uye adzoserwe
• Pombi yeropa: Pombi ye centrifugal kana kuti roller inofambisa ropa kufamba mudunhu
• Muchina weokisijeni wemembrane: Mapapu ekugadzira anowedzera okisijeni uye anobvisa carbon dioxide
• Heat exchanger: Inodziisa ropa kusvika patembiricha yemuviri risati radzoserwa kumurwere
• Monitoring masisitimu: Kuramba uchitarisa kuyerera kweropa, kumanikidzwa, huwandu hweoxygen, uye mashandiro edunhu

Ndiani Anogona Kubatsirwa neECMO?

ECMO inogona kufungwa nezvayo kune varwere vane:

• Chirwere chemwoyo chinonetsa (ARDS) chisingashande zvakanaka kana paine nzira yakakwana yekubatsira vanhu vanofema mweya.
• Mabayo akanyanya anokonzerwa nehutachiona hwebhakitiriya, hwehutachiona, kana hwefungus zvichikonzera kusagadzikana kweropa
• Kuvhunduka kwemwoyo hakupinduri kurapwa kwechiremba kana rutsigiro rwekutenderera kweropa nemagetsi
• Kumira kwemwoyo kusingadzoreki, semutsidziri wemoyo uri kunze kwemuviri kana kuti eCPR
• Kukundikana kubvisa kubva pamwoyo mushure mekuvhiyiwa kwemwoyo
• Myocarditis yakaoma ine hemodynamic compromise
• Kuvharika kukuru kwemapapu
• Senzira yekusvitsa mwoyo kana mapapu kune chimwe chinhu, kana nzira yekusvitsa ventricle assist device (VAD)

Sarudzo yekutanga ECMO inotorwa nechikwata chevanorapa vanorwara zvakanyanya pamwe nechikwata cheECMO. Inochengeterwa varwere vane zvirwere zvakakomba, zvinogona kudzoka uye vasina kupindura kumishonga yese yemazuva ano.

ECMO haina kukodzera varwere vese vanorwara zvakanyanya, uye timu ichaongorora zvinhu zvinosanganisira kuongororwa kwacho, mukana wekupora, zera remurwere, zvimwe zvirwere, uye nguva yekurwara isati yatanga.

Benefits

Kana zvataurwa, ECMO inogona kupa mabhenefiti anotevera:

• Rutsigiro runoponesa hupenyu: ECMO inogona kuchengetedza hupenyu muvarwere vangadai vasina kurarama nekutadza kwakanyanya kwemoyo kana kufema.
• Kuzorora kwenhengo uye kupora: Nekutora basa remoyo nemapapu, ECMO inobvumira nhengo idzi kuzorora nekupora, zvichigonesa kupora.
• Kuvandudzwa kweoxygen: ECMO inopa oxygen yakakwana mumuviri, zvichiita kuti nhengo dzinokosha dzishande zvakanaka panguva iyo chirwere chiripo chichirapwa.
• Kukuvara kwemapapu kunokonzerwa nekufema kunoderedza: Mukutadza kufema, ECMO inogona kuderedza mashandiro emuchina wekufema, zvichideredza kukuvara kwakanyanya kumapapu.
• Kuwanda kwehuwandu hwekupona: Ongororo dzakaratidza kuti varwere vanogamuchira rutsigiro rweECMO panguva yakakodzera kuti vawane zviratidzo zvakakodzera vanorarama zviri nani kana tichienzanisa nekurapwa kwakajairika chete.
• Versatility: ECMO inogona kugadzirwa kuti itsigire kufema, kutsigira mwoyo, kana zvese zviri zviviri, zvichienderana nezvinodiwa nemurwere.

Njodzi uye Matambudziko

ECMO inzira yekurapa ine njodzi huru. Kunyange zvazvo ichigona kuponesa hupenyu, varwere nemhuri vanofanira kuziva nezvenjodzi huru dzinobatanidzwa:

• Kubuda ropa kukuru: Zvakataurwa muvarwere vanosvika 30–40% veECMO, nekuda kwekusaita ropa rakawanda mumuviri kunodiwa kudzivirira kugwinha kweropa muchikamu cheropa. Kubuda ropa kunogona kuitika panzvimbo dzinoiswa ropa, mumapapu, mudumbu, kana muuropi.
• Thrombosis: Maronda eropa anogona kuumbwa muchikamu cheropa kana mumurwere, zvichikonzera sitiroko, pulmonary embolism, kana kuti limb ishaemia.
• Kushaya simba kwemuviri: Kunyanya kana paine femoral arterial cannulation muVA-ECMO, kuyerera kweropa kushoma kuenda kugumbo kunogona kukonzera kukuvara kwenyama. Distal perfusion cannulas dzinogona kushandiswa kuderedza njodzi iyi.
• Kurohwa: Kurohwa kwe ischemic ne hemorrhagic kunogona kuitika panguva yekutsigira ECMO.
• Kurwara: Kugara kwenguva refu mutsinga dzeropa uye kugara muICU zvinowedzera njodzi yezvirwere zveropa uye nzvimbo yekuvhiyiwa.
• Kubviswa kweropa: Kuparadzwa kwemasero matsvuku eropa nemagetsi paanenge achipfuura nepombi nepadunhu.
• Kukundikana kweitsvo: Zvinogona kuitika nekuda kwechirwere chiripo, kusagadzikana kweropa, kana zvinhu zvine chekuita neECMO. Vamwe varwere vanoda dialysis panguva yekutsigira ECMO.
• Matambudziko emakanika: Kusanganisira kutadza kushanda kweoxygenator, air embolism, kuputika kwemachubhu, uye kutadza kushanda zvakanaka kwepombi. Izvi zvinoda kupindira nekukasika kubva kuchikwata cheECMO.

Huwandu hwevanhu vanofa neECMO huchiri kukura, sezvo varwere ava vachirwara zvakanyanya. Huwandu hwevanhu vanopona hunosiyana zvichienderana nezviratidzo: vanenge 50–60% yeECMO yekufema uye 30–45% yeECMO yemwoyo, zvichienderana nedata kubva kuExtracorporeal Life Support Organisation (ELSO).

kupora

Kupora kubva kuECMO kunoenderana nemamiriro ezvinhu akaita kuti pave nekurapwa:

• Nguva yerutsigiro rweECMO inosiyana-siyana, kubva pamazuva kusvika kumavhiki, zvichienderana nekurapwa kwemurwere uye mhinduro yake kukurapa.
• Kana mwoyo nemapapu zvapora zvakakwana, timu yeECMO ichaderedza rutsigiro zvishoma nezvishoma uye ichaongorora kugona kwemurwere kushanda ega, nzira inonzi kuyamwisa mwana.
• Kubvisa macannula, kana kubviswa kwecannula, kunoitwa kana murwere abviswa pabasa reECMO.
• Varwere vanowanzo gara muICU kuti varambe vachiongororwa mushure mekunge ECMO yamiswa.
• Kurapwa, kusanganisira physiotherapy uye kurapa kufema, chinhu chakakosha pakupora mushure meECMO
• Kupora kwakakwana kunogona kutora mavhiki kusvika kumwedzi, zvichienderana nekuoma kwechirwere uye hutano hwemurwere.

Mibvunzo Inonyanya Kubvunzwa

1. ECMO inoshanda sei?

ECMO inoshanda nekubvisa ropa kubva kumurwere, yoriisa mu oxygen kuburikidza ne mapapu ekugadzira (membrane oxygenator), yozoridzosera mumuviri. Maitiro aya anotsigira varwere vane mwoyo nemapapu zvisiri kushanda zvakanaka.

2. Ndiani anokodzera ECMO?

Kukodzera kuwana ECMO kunowanzo sanganisira varwere vane kutadza kukuru kwekufema kana kwemwoyo vasina kupindura kurapwa kwakajairika. Sarudzo inotorwa nevanorapa vanonyanya kurapa pamwe nechikwata cheECMO zvichibva pamamiriro ezvinhu ekiriniki. ECMO haisi nzira inodiwa kana kurongwa nevarwere kana mhuri; inotangwa senzira yekukurumidzira kana yekukurumidzira nechikwata chekurapa.

3. Nzira yacho inorwadza here kana kuti haina kugadzikana?

Varwere vari paECMO vanowanzo pihwa mushonga wekuzorora uye vari muchikamu chevarwere vanorwara zvakanyanya. Kunyange zvazvo nzira yekubvisa masero eropa iri nzira inopindira inosanganisira kuisa machubhu makuru mutsinga huru dzeropa, varwere vanopihwa mushonga wekuzorora panguva iyi uye munguva yese yekurapwa kweECMO. Kuramba vachitarisa kunoita kuti murwere anzwe akasununguka uye akachengeteka.

4. Kurapwa kweECMO kunogara kwenguva yakareba sei?

Nguva yeECMO inosiyana kubva pamazuva kusvika pamavhiki, zvichienderana nemamiriro ezvinhu aripo uye mhinduro yemurwere kumishonga. Chikwata cheECMO chinogara chichiongorora kana mwoyo nemapapu emurwere zviri kupora zvakakwana kuti zvibvumire kuregedzwa kubva pakutsigira.

5. Ngozi dzipi dziripo dzeECMO?

ECMO ine njodzi huru dzinosanganisira kubuda ropa zvakanyanya, thrombosis, sitiroko, ischemia yemitezo, hutachiona, kubuda ropa, kutadza kushanda kweitsvo, uye matambudziko emagetsi. Njodzi idzi dzinoyerwa zvichienderana nemamiriro ezvinhu anoisa ECMO panjodzi.

6. ECMO inogona here kurapa chirwere chiripo?

Kwete. ECMO hairapi chirwere chiripo. Inopa rutsigiro rwechinguvana kumwoyo nemapapu ukuwo timu yezvekurapa ichirapa chirwere chiripo. ECMO inotenga nguva yekuti nhengo dzemuviri dzizorore uye dzipore, kana kuti inoshanda sezambuko rekuwedzera nzira dzakadai sekuisirwa nhengo.

7. Varwere vari paECMO vanorarama kwenguva yakareba sei?

Mwero wekupona unosiyana zvichienderana nechiratidzo. Sekureva kweExtracorporeal Life Support Organisation (ELSO), kupona kunenge kuri pakati pe50–60% neECMO yekufema uye 30–45% neECMO yemwoyo. Zvinobuda mumunhu mumwe nemumwe zvinoenderana nekuongororwa kwacho, zera remurwere, zvirwere zvinouya, uye nguva yekutanga kweECMO.

8. ECMO inowanikwa here muzvipatara zvese?

Kwete. ECMO inoda michina yakasarudzika, vashandi vakadzidziswa vanosanganisira vanachiremba veperfusion, vanachiremba ve intensivists, uye vanachiremba vemwoyo, uye zvivakwa zveICU zvakatsaurirwa. Inowanikwa chete muzvipatara zvakasarudzwa zvine mapurogiramu eECMO akajairwa.

9. Nhengo dzemhuri dzinogona kushanyira murwere ari paECMO here?

Mitemo yekushanyira varwere vari muICU inosiyana zvichienderana nechipatara nemamiriro ekurapa. Kazhinji, nhengo dzemhuri dzinogona kushanyira varwere vari paECMO, kunyange hazvo nguva yekushanyira varwere nehuwandu hwevashanyi zvingave zvishoma. ECMO nechikwata cheICU vachapa gwara rekushanyira varwere.

10. Ndingadzidza sei zvakawanda nezveECMO kuApollo Hospitals?

ECMO inowanikwa kuzvipatara zveApollo zvakasarudzwa zvine mapurogiramu eECMO akatsaurirwa. Kuti uwane rumwe ruzivo, taura nebazi reApollo Hospitals riri pedyo newe. Kana paine emergency, taura nedhipatimendi reApollo emergency riri pedyo newe kana kufonera 1066.

Emergency Contact Information

ECMO inowanikwa muzvipatara zveApollo zvakasarudzwa zvine mapurogiramu eECMO akatsaurirwa. ECMO inotangwa senzira yekukurumidzira kana yekukurumidzira nechikwata chekurapa uye haisi nzira inorongwa nevarwere kana mhuri.

Kana paine njodzi, taura nedhipatimendi rekukurumidzira reApollo riri pedyo newe kana kufonera 1066 (Apollo Hospitals emergency helpline).

Kana nhengo yemhuri iri kurwara zvakanyanya uye muchida kunzwisisa kana ECMO ingavepo kana yakakodzera, taurai zvakananga nechikwata chekurapa chinodzivirira kurwara zvakanyanya kana chevarwere vari kuchipatara chiri kutarisirwa murwere.