ECMO

CaO2 = 1.34 * Hg + PaO2 * 0.003 = 1.34 * 15g/dL + 90 * 0.003 = 20 g/dL <- 13.4 must be used in Fick's rather than 1.34 to convert Hg units from g/dl to g/mL

DO2 = CO * CaO2 = 5 L/m * 20 g/dL = 50dL/min * 20g/dl = 1000g/min = 1000ml/min (normal varies widely: 650ml/min to 1400ml/min)

VO2 = 3-5 ml/kg/min (adults) = 210-300 ml/min (in 70kg adult)

4-6 in children

5-8 in infants

DO2 : VO2 is 4-5 : 1 anaerobic metabolism starts at ratio of 2:1

ECLS DO2 = CpostoxygenatorO2 x circuit blood flow

UFH binds to AT, inhibits fXa and thrombin; UFH also releases TFPI which inhibits TF-FVIIa; half life 30-60min, liver metabolized renally secreted

Bivalirudin directly inhibits thrombin; 25-35min half life; 80% secretion by proteolytic enzymes 20% by kidneys

Argatroban directly inhibits thrombin; 40-50min half life; liver metabolized

aPTT is falsely shortened by acute phase reactants

antiXa can be falsely low with elevated plasma hemoglobin and hyperbilirubinemia; assay must not add AT or dextra sulfate which can falsely overestimate; neext AT > 50-80%

1U RBC has 130-240ml of packed RBC in 225-350ml volume (Hct is 55-65%); 50-80g Hg (23g/dl) and 150-250mg of Fe

Cryo has 150mg of finbrinogen and 80IU of fVIII in 5-20ml of plasma; 5-6U per dose; 1 dose will raise fibrinogen in a 70kg person by 35mg/dl


ECCOR 10ml/kg/min

VV ECMO 50-80ml/kg/min