I-Extracorporeal Membrane Oxygenation (ECMO) System

Umhlahlandlela ophelele wobuchwepheshe bokusekela impilo be-ECMO ezibhedlela zase-Apollo

Uhlolojikelele

I-Extracorporeal Membrane Oxygenation (ECMO) ubuchwepheshe obusekela impilo obunikeza ukwesekwa kwenhliziyo nokuphefumula isikhathi eside ezigulini ezinenhliziyo namaphaphu angakwazi ukusebenza kahle. Lokhu kungenelela kwezokwelapha okuthuthukisiwe kusetshenziswa ezindaweni zokunakekelwa okubucayi, ikakhulukazi amayunithi okunakekelwa okujulile (ama-ICU), ezigulini ezihlushwa ukwehluleka okukhulu kokuphefumula noma kwenhliziyo. Uhlelo lwe-ECMO luvelele ngenxa yekhono lalo lokufaka umoya-mpilo egazini ngaphandle komzimba, okuvumela inhliziyo namaphaphu isikhathi sokuphulukiswa noma sokululama.

Uhlelo lwe-ECMO luqukethe iphampu ehambisa igazi ngephaphu lokwenziwa (i-membrane oxygenator) lapho kususwa khona i-carbon dioxide bese kufakwa umoya-mpilo ngaphambi kokuba igazi libuyiselwe esigulini. Le nqubo ilingisa imisebenzi yemvelo yenhliziyo namaphaphu, inikeza ukwesekwa okubalulekile phakathi nezimo ezisongela ukuphila.

Uhlobo Lwenqubo

I-ECMO iwuhlelo lokusekela impilo oluhlasela kakhulu, olusebenzisa izinsiza eziningi olusetshenziswa emayunithi okunakekelwa okujulile ezigulini ezinokwehluleka okukhulu kokuphefumula noma kwenhliziyo okungase kuguqulwe okungaphenduli ekwelashweni okuvamile. Akuyona inqubo evamile futhi ayifani nokungenelela kokuxilonga noma kokwelapha okungahlanganisi kakhulu.

I-ECMO ihilela:

• Ukususwa kwemithambo yegazi emikhulu: Ukufakwa kwama-cannula amakhulu emithanjeni yegazi emikhulu, okuvame ukudinga ukunqunywa ngokuhlinzwa kwemithambo yentamo, imbobo, noma yesifuba. Ubukhulu kanye nokubekwa kwala ma-cannula kunezingozi ezihambisana nenqubo.
• Ukuvimbela ukujiya kwegazi okugcwele nge-heparin: Lokhu kuyadingeka ukuze kuvinjelwe ukujiya kwegazi esimisweni esingaphandle komzimba. Lokhu kuvimbela ukujiya kwegazi kwandisa ingozi yokopha emzimbeni wonke.
• Ukuqapha okuqhubekayo kwezinga le-ICU: I-ECMO idinga ukubhekwa yithimba elikhethekile le-ECMO, okuhlanganisa odokotela abahlinza igazi, odokotela abahlinzayo, odokotela abahlinza inhliziyo, kanye nabahlengikazi abanakekela abantu abagula kakhulu. Iziguli ezisebenzisa i-ECMO zidinga ukubhekwa ubusuku nemini eceleni kombhede.
• Izingozi ezinkulu: Lokhu kufaka phakathi ukopha okukhulu, i-thrombosis, i-ischaemia yemilenze, isifo sohlangothi, ukutheleleka, i-hemolysis, ukwehluleka kwezinso, kanye nezinkinga zesekethe yomshini njengokwehluleka kwe-oxygenator noma ukuqhuma kwamapayipi.

I-ECMO iqalwa ngabantu abasebenzisa amandla okusebenza kanye namaqembu aqeqeshwe yi-ECMO njengokungenelela okuphuthumayo noma okuphuthumayo. Akuyona inqubo ehlelwa yiziguli noma imindeni. Isinqumo sokubeka isiguli ku-ECMO senziwa yithimba lezokwelapha eliselaphayo ngokusekelwe ebunzimeni besimo sezokwelapha kanye namathuba okululama.

Injongo

Inhloso eyinhloko yohlelo lwe-ECMO ukuhlinzeka ngokusekelwa kwesikhashana kwemishini lapho inhliziyo, amaphaphu, noma kokubili kwehluleka futhi kungaphenduli ekwelashweni okuvamile. I-ECMO ivumela lezi zitho ukuba ziphumule futhi zilulame ngenkathi isimo esiyisisekelo selashwa.

Lolu hlelo lusetshenziswa ezimweni ezilandelayo zezokwelapha:

• Ukwehluleka okukhulu kokuphefumula: Kubandakanya i-acute respiratory distress syndrome (ARDS), i-pneumonia enzima, kanye nokwehluleka kokuphefumula okubangelwa yi-COVID-19 noma ezinye izifo, lapho umoya wodwa unganele.
• Ukwehluleka kwenhliziyo: Kubandakanya ukushaqeka kwenhliziyo, ukumiswa kwenhliziyo okungalawuleki, kanye nokwehluleka ukuyeka ukusebenza kwe-cardiopulmonary bypass ngemuva kokuhlinzwa kwenhliziyo.
• Ibhuloho lokufakelwa: I-ECMO ingasekela iziguli ngesikhathi zilinde ukufakelwa inhliziyo noma amaphaphu.
• Ibhuloho lokululama: Ukunikeza isikhathi sokuba inhliziyo noma amaphaphu alulame ekulimaleni noma ekuguleni okukhulu.
• Ibhuloho lesinqumo: Ukugcina ukugeleza kwegazi ezithweni zomzimba ngenkathi ithimba lezokwelapha lihlola ukuthi zikhona yini ezinye izindlela zokwelapha ezitholakalayo.

Indlela Esebenza

Uhlelo lwe-ECMO lusebenza ngokudonsa igazi esigulini nge-cannula enkulu, lidluliswe nge-membrane oxygenator lapho kufakwa khona umoya-mpilo bese kususwa i-carbon dioxide, kufudumeze igazi liye ekushiseni komzimba, bese libuyiselwa esigulini ngenye i-cannula. Iphampu iqhuba igazi ngesekethe.

Kukhona ukucushwa okubili okuyinhloko:

I-Veno-Venous (VV) ECMO

Ku-VV-ECMO, igazi likhishwa bese libuyiselwa ohlelweni lwemithambo yegazi. Lokhu kulungiswa kunikeza ukwesekwa kokuphefumula kuphela, okuhlanganisa ukufuthwa komoya-mpilo kanye nokususwa kwe-carbon dioxide. Kusetshenziswa lapho amaphaphu ehluleka kodwa inhliziyo isebenza kahle. Inhliziyo yesiguli iyaqhubeka nokupompa igazi emzimbeni.

I-ECMO ye-Veno-Arterial (VA)

Ku-VA-ECMO, igazi likhishwa ohlelweni lwemithambo yegazi bese libuyiselwa ohlelweni lwemithambo yegazi. Lokhu kulungiswa kunikeza kokubili ukwesekwa kwenhliziyo nokuphefumula. Kusetshenziswa lapho kokubili inhliziyo namaphaphu kwehluleka, noma lapho inhliziyo yodwa yehluleka, njengalapho inhliziyo ishaqeka noma ukuboshwa kwenhliziyo.

Izingxenye ezibalulekile zesekethe ye-ECMO zifaka:

• Ama-Cannula: Amapayipi amakhulu afakwa emithanjeni yegazi emikhulu ukuze kukhishwe igazi futhi kubuyiselwe igazi
• Iphampu yegazi: Iphampu ye-centrifugal noma ye-roller eqhuba ukugeleza kwegazi kulo lonke isekethe
• I-membrane oxygenator: Iphaphu lokwenziwa elengeza umoya-mpilo futhi lisuse i-carbon dioxide
• Heat umzimba: Kufudumeza igazi lifinyelele ekushiseni komzimba ngaphambi kokuba libuyiselwe esigulini
• Amasistimu okuqapha: Ukuqapha okuqhubekayo kokugeleza kwegazi, izingcindezi, amazinga okungenisa umoya-mpilo, kanye nomsebenzi wesekethe

Ubani Ongazuza Ku-ECMO?

I-ECMO ingacatshangelwa iziguli ezine:

• I-ARDS enzima (i-acute respiratory distress syndrome) engasabeli ekuphathweni kahle komoya wokuphefumula
• I-pneumonia enzima ebangelwa ukutheleleka ngamagciwane, amagciwane, noma isikhunta okubangela ukuntuleka kwe-oksijini okungapheli
• Ukushaqeka kwenhliziyo okungaphenduli ekwelashweni kwezokwelapha noma ekusekelweni kokujikeleza kwegazi ngomshini
• Ukuma kwenhliziyo okuphambene, njengokuvuselelwa kwenhliziyo okungaphandle komzimba noma i-eCPR
• Ukwehluleka ukuyeka ukusebenza kwe-cardiopulmonary bypass ngemuva kokuhlinzwa kwenhliziyo
• I-myocarditis ebukhali ene-hemodynamic compromise
• I-embolism enkulu yamaphaphu
• Njengebhuloho eliya ekufakweni kwenhliziyo noma kwamaphaphu, noma ibhuloho eliya kudivayisi yokusiza nge-ventricular (VAD)

Isinqumo sokuqala i-ECMO senziwa yithimba lokunakekelwa okujulile kanye ne-ECMO. Sigcinelwe iziguli ezinezimo ezinzima, ezingase ziguquke futhi ezingakaphenduli kuzo zonke izindlela zokwelapha ezivamile.

I-ECMO ayifaneleki kubo bonke abagula kakhulu, futhi ithimba lizohlola izici ezihlanganisa ukuxilongwa okuyisisekelo, amathuba okululama, ubudala besiguli, izifo ezihambisana naso, kanye nobude besikhathi sokugula ngaphambi kokuqala.

Izinzuzo

Uma kuboniswe, i-ECMO inganikeza izinzuzo ezilandelayo:

• Usekelo olusindisa impilo: I-ECMO ingasekela impilo ezigulini ebezingeke zisinde ekuhlulekeni okukhulu kwenhliziyo noma kokuphefumula.
• Ukuphumula nokululama kwezitho zomzimba: Ngokuthatha umsebenzi wenhliziyo namaphaphu, i-ECMO ivumela lezi zitho ukuthi ziphumule futhi zelapheke, okungenzeka ukuthi zenze ukuthi zilulame.
• Ukuthuthukiswa komoya-mpilo: I-ECMO inikeza umoya-mpilo owanele emzimbeni, okuvumela izitho ezibalulekile ukuthi zisebenze ngenkathi isimo esiyisisekelo siphathwa.
• Ukulimala kwamaphaphu okubangelwa ukuphefumula okuncishisiwe: Uma ukuphefumula kwehluleka, i-ECMO ingavumela ukuthi izilungiselelo zomshini wokuphefumula zincishiswe, okunciphisa umonakalo owengeziwe emaphashini.
• Amazinga okusinda athuthukisiwe: Ucwaningo lubonise ukuthi iziguli ezithola ukwesekwa kwe-ECMO ngesikhathi esifanele ukuze zithole izimpawu ezifanele zithuthukise ukusinda kwazo uma kuqhathaniswa nokwelashwa okuvamile kuphela.
• Ukuhlukahluka: I-ECMO ingalungiselelwa ukwesekwa kokuphefumula, ukwesekwa kwenhliziyo, noma kokubili, kuye ngezidingo zesiguli.

Izingozi Nezinkinga

I-ECMO iyindlela yokungenelela enobungozi obukhulu. Nakuba ingasindisa impilo, iziguli kanye nemindeni kufanele baqaphele izingozi ezibalulekile ezihilelekile:

• Ukopha okukhulu: Kubikwe kubantu abafinyelela ku-30–40% beziguli ze-ECMO, ngenxa yokungasebenzi kahle kwesistimu yokuvimbela ukujiya kwegazi okudingekayo ukuvimbela ukujiya kwegazi esimisweni. Ukopha kungenzeka ezindaweni zokukhipha igazi, emaphashini, emathunjini, noma ebuchosheni.
• I-Thrombosis: Amahlule egazi angakheka esimisweni noma esigulini, okungase kuholele ekushayweni yisifo sohlangothi, i-pulmonary embolism, noma i-limb ishaemia.
• I-Ischaemia Yezitho: Ikakhulukazi ngokususwa kwemithambo ye-femoral artery ku-VA-ECMO, ukugeleza kwegazi okunciphile emlenzeni kungabangela ukulimala kwezicubu. Ama-cannula okugeleza kwegazi angase asetshenziswe ukunciphisa le ngozi.
• Istroke: Kokubili ukushaywa yi-ischemic kanye ne-hemorrhagic kungenzeka ngesikhathi sokusekelwa kwe-ECMO.
• ukutheleleka: Ukufinyelela isikhathi eside emithanjeni yegazi kanye nokuhlala e-ICU kwandisa ingozi yokutheleleka kwegazi kanye nokutheleleka endaweni yokuhlinzwa.
• I-Haemolysis: Ukubhujiswa kwezicubu ezibomvu zegazi ngomshini njengoba zidlula ephampini nasesiyingini.
• Ukwehluleka kwezinso: Kungase kwenzeke ngenxa yesifo esiyisisekelo, ukungazinzi kwe-hemodynamic, noma izici ezihlobene ne-ECMO. Ezinye iziguli zidinga i-dialysis ngesikhathi sokusekelwa kwe-ECMO.
• Izinkinga zemishini: Kubandakanya ukwehluleka kwe-oxygenator, i-air embolism, ukuqhuma kwamapayipi, kanye nokungasebenzi kahle kwephampu. Lokhu kudinga ukungenelela okusheshayo yithimba le-ECMO.

Izinga lokufa lilonke leziguli ezidinga i-ECMO lisalokhu libalulekile, njengoba lezi ziguli ngokwencazelo zigula kakhulu. Izinga lokusinda liyahlukahluka ngokusekelwe ezinkomba: cishe u-50-60% we-ECMO yokuphefumula kanye no-30-45% we-ECMO yenhliziyo, ngokusho kwedatha evela kwi-Extracorporeal Life Support Organisation (ELSO).

Lokubuyisela

Ukululama kusuka ku-ECMO kuncike esimweni esiyisisekelo esibangele ukwelashwa:

• Isikhathi sokusekelwa kwe-ECMO siyahlukahluka kakhulu, kusukela ezinsukwini kuya emavikini, kuye ngokuthi isiguli siphila kanjani kanye nendlela esisabela ngayo ekwelashweni.
• Uma inhliziyo namaphaphu sekupholile ngokwanele, ithimba le-ECMO lizonciphisa kancane kancane ukwesekwa futhi lihlole ikhono lesiguli lokusebenza ngokuzimela, inqubo ebizwa ngokuthi ukukhumula.
• Ukususa i-cannula, noma ukususwa kwama-cannula, kwenziwa uma isiguli sesilunyuliwe ngempumelelo ekusekelweni kwe-ECMO.
• Iziguli ngokuvamile zihlala e-ICU ukuze ziqashwe njalo ngemva kokuba i-ECMO ingasasebenzi.
• Ukuvuselelwa, okuhlanganisa i-physiotherapy kanye nokwelashwa kokuphefumula, kuyingxenye ebalulekile yokululama ngemva kwe-ECMO
• Ukululama okuphelele kungathatha amasonto kuya ezinyangeni, kuye ngokuthi isifo sibucayi kangakanani kanye nempilo yesiguli iyonke.

imibuzo ejwayelekile ukubuzwa

1. Isebenza kanjani i-ECMO?

I-ECMO isebenza ngokudonsa igazi esigulini, ilifake umoya-mpilo ngephaphu lokwenziwa (i-membrane oxygenator), bese ilibuyisela emzimbeni. Le nqubo isekela iziguli ezinenhliziyo namaphaphu angasebenzi kahle.

2. Ubani ofanelekela i-ECMO?

Ukufaneleka kwe-ECMO kuvame ukufaka iziguli ezinokukhubazeka okukhulu kokuphefumula noma kwenhliziyo ezingasabelanga ekwelashweni okuvamile. Isinqumo senziwa yithimba lokunakekelwa okujulile lokwelapha kanye nethimba le-ECMO ngokusekelwe esimweni sezokwelapha. I-ECMO akuyona inqubo ecelwa noma ehlelwa yiziguli noma imindeni; iqalwa njengokungenelela okuphuthumayo noma okuphuthumayo yithimba lezokwelapha.

3. Ingabe inqubo ibuhlungu noma ayikhululekile?

Iziguli ezisebenzisa i-ECMO zivame ukutholiswa futhi zisegumbini lokunakekelwa okujulile. Nakuba inqubo yokukhipha indle iyinqubo ehlaselayo ehilela ukufaka amapayipi amakhulu emithanjeni yegazi emikhulu, iziguli ziyatholiswa phakathi nalokhu naphakathi nokwelashwa kwe-ECMO. Ukuqapha okuqhubekayo kuqinisekisa induduzo nokuphepha kwesiguli.

4. Ukwelashwa kwe-ECMO kuthatha isikhathi esingakanani?

Ubude be-ECMO buyahlukahluka kusukela ezinsukwini kuya emavikini, kuye ngesimo esiyisisekelo kanye nempendulo yesiguli ekwelashweni. Ithimba le-ECMO lihlala lihlola ukuthi inhliziyo namaphaphu esiguli kuyalulama ngokwanele yini ukuvumela ukulunyulwa ekusekelweni.

5. Yiziphi izingozi ze-ECMO?

I-ECMO inezingozi ezinkulu ezifaka phakathi ukopha okukhulu, i-thrombosis, isifo sohlangothi, i-ischaemia yemilenze, ukutheleleka, i-hemolysis, ukwehluleka kwezinso, kanye nezinkinga zesekethe yomshini. Lezi zingozi zilinganiswa ngesimo esisongela impilo sezimo lapho i-ECMO isetshenziselwa khona.

6. Ingabe i-ECMO ingayiqeda inkinga eyisisekelo?

Cha. I-ECMO ayilaphi lesi sifo esiyisisekelo. Ihlinzeka ngokusekelwa kwesikhashana kwenhliziyo namaphaphu ngenkathi ithimba lezokwelapha lilapha lesi simo esiyisisekelo. I-ECMO ithenga isikhathi sokuba izitho ziphumule futhi zilulame, noma isebenza njengebhuloho lokungenelela okwengeziwe njengokufakelwa izitho.

7. Lingakanani izinga lokusinda kweziguli ezisebenzisa i-ECMO?

Amazinga okusinda ayahlukahluka ngokusekelwe enkombeni. Ngokusho kwe-Extracorporeal Life Support Organisation (ELSO), ukusinda cishe kungama-50-60% kwi-ECMO yokuphefumula kanye nama-30-45% kwi-ECMO yenhliziyo. Imiphumela yomuntu ngamunye incike ekuxilongweni okuyisisekelo, iminyaka yesiguli, izifo ezihambisana naso, kanye nesikhathi sokuqala kwe-ECMO.

8. Ingabe i-ECMO iyatholakala kuzo zonke izibhedlela?

Cha. I-ECMO idinga imishini ekhethekile, abasebenzi abaqeqeshwe okuhlanganisa odokotela abahlinzayo nge-perfusion, odokotela abahlinzayo, kanye nodokotela abahlinzayo benhliziyo, kanye nengqalasizinda ye-ICU ezinikele. Itholakala kuphela ezibhedlela ezithile ezinezinhlelo ze-ECMO ezisunguliwe.

9. Ingabe amalungu omndeni angavakashela isiguli ku-ECMO?

Izinqubomgomo zokuvakashela i-ICU ziyahlukahluka kuye ngesimo sesibhedlela kanye nesimo sezokwelapha. Ezimweni eziningi, amalungu omndeni angavakashela iziguli nge-ECMO, yize amahora okuvakashela kanye nenani lezivakashi kungase kuncishiswe. Ithimba le-ECMO kanye ne-ICU lizonikeza isiqondiso ngokuvakasha.

10. Ngingafunda kanjani okwengeziwe nge-ECMO ezibhedlela zase-Apollo?

I-ECMO iyatholakala ezibhedlela ze-Apollo ezikhethiwe ezinezinhlelo ze-ECMO ezizinikele. Ukuze uthole ulwazi, xhumana nesikhungo sakho sezibhedlela ze-Apollo esiseduze. Uma kunezimo eziphuthumayo, xhumana nomnyango wakho wezimo eziphuthumayo we-Apollo oseduze noma ushayele ku-1066.

Ulwazi Lokuxhumana Oluphuthumayo

I-ECMO iyatholakala ezibhedlela ezithile zase-Apollo ezinezinhlelo ze-ECMO ezizinikele. I-ECMO iqalwa njengokungenelela okuphuthumayo noma okuphuthumayo yithimba lezokwelapha elilaphayo futhi akuyona inqubo ehlelwa yiziguli noma imindeni.

Uma kunezimo eziphuthumayo, xhumana nomnyango wezimo eziphuthumayo wase-Apollo oseduze nawe noma ushayele ku-1066 (ucingo losizo oluphuthumayo lwe-Apollo Hospitals).

Uma ilungu lomndeni ligula kakhulu futhi ufisa ukuqonda ukuthi i-ECMO ingatholakala noma ifanelekile, khuluma ngqo nethimba lochwepheshe bezokwelapha abagula kakhulu noma lokunakekelwa okubucayi esibhedlela lapho isiguli sinakekelwa khona.