I-ECMO (I-Extracorporeal Membrane Oxygenation)

-Delile

• Ngubani odinga i-ECMO?
• Izinsana
• Izingane
• Abantu abadala
• Yiziphi izinhlobo ze-ECMO?
• Ngiyilungiselela kanjani i-ECMO?
• Kwenzekani ngesikhathi se-ECMO?
• Yiziphi izinkinga ezihambisana ne-ECMO?
• Kwenzekani ngemuva kwe-ECMO?

Kuyini i-extracorporeal membrane oxygenation (ECMO)?

I-extracorporeal membrane oxygenation (ECMO) iyindlela yokunikeza ukuphefumula nokuxhaswa kwenhliziyo. Ngokuvamile isetshenziselwa izinsana ezigula kakhulu ezinezinkinga zenhliziyo noma zamaphaphu. I-ECMO ingahlinzeka ngomoya-mpilo odingekayo enganeni ngenkathi odokotela belapha isimo esingaphansi. Izingane ezindala nabantu abadala bangazuza naku-ECMO ngaphansi kwezimo ezithile.

I-ECMO isebenzisa uhlobo lwamaphaphu okufakelwa abizwa nge-membrane oxygenator ukwenza i-oxygenate igazi. Ihlangana nesifudumezi nesihlungi sokuphakela umoya-mpilo egazini bese ulibuyisela emzimbeni.

Ngubani odinga i-ECMO?

Odokotela bakubeka ku-ECMO ngoba unezinkinga ezinkulu, kodwa eziguqukayo, zenhliziyo noma zamaphaphu. I-ECMO ithatha umsebenzi wenhliziyo namaphaphu. Lokhu kukunika ithuba lokululama.

I-ECMO inganikeza izinhliziyo ezincane namaphaphu ezingane ezisanda kuzalwa isikhathi esithe xaxa sokukhula. I-ECMO ingaba futhi "yibhuloho" ngaphambi nangemva kokwelashwa njengokuhlinzwa kwenhliziyo.

Ngokusho kweSibhedlela Sezingane saseCincinnati, i-ECMO iyadingeka kuphela ezimweni ezimbi kakhulu. Ngokuvamile, lokhu kungemuva kokuba ezinye izindlela zokusekela zingaphumelelanga. Ngaphandle kwe-ECMO, inani lokusinda ezimweni ezinjalo lingamaphesenti angama-20 noma ngaphansi. Nge-ECMO, izinga lokusinda lingakhuphukela kumaphesenti angama-60.

Izinsana

Ezinganeni, izimo ezingadinga i-ECMO zifaka:

• isifo sokuphefumula (ubunzima bokuphefumula)
• i-hernia e-congenital diaphragmatic (imbobo ku-diaphragm)
• i-meconium aspiration syndrome (ukuhogela imikhiqizo edoti)
• umfutho wegazi ophakeme wamaphaphu (umfutho wegazi ophakeme emithanjeni yamaphaphu)
• inyumoniya enamandla
• ukwehluleka ukuphefumula
• ukuboshwa kwenhliziyo
• ukuhlinzwa kwenhliziyo
• sepsis

Izingane

Ingane ingadinga i-ECMO uma ihlangabezana:

• inyumoniya
• izifo ezinzima
• ukukhubazeka kwenhliziyo okuzelwe
• ukuhlinzwa kwenhliziyo
• ukuhlukumezeka nezinye izimo eziphuthumayo
• ukufisa izinto ezinobuthi emaphashini
• isifuba somoya

Abantu abadala

Kumuntu omdala, izimo ezingadinga i-ECMO zifaka:

• inyumoniya
• ukuhlukumezeka nezinye izimo eziphuthumayo
• ukwesekwa kwenhliziyo ngemuva kokwehluleka kwenhliziyo
• izifo ezinzima

Yiziphi izinhlobo ze-ECMO?

I-ECMO inezingxenye eziningana, kufaka phakathi:

• cannulae: ama-catheters amakhulu (amashubhu) afakwa emithanjeni yegazi ukususa nokubuyisa igazi
• ulwelwesi oxygenator: iphaphu lokufakelwa elenza umoya-mpilo wegazi
• ukufudumala nokuhlunga: imishini efudumeza futhi ihlunge igazi ngaphambi kokuba i-cannulae ilibuyisele emzimbeni

Ngesikhathi se-ECMO, i-cannulae iphampa igazi eliphelelwe umoya lomoya-mpilo. I-membrane oxygenator bese ifaka umoya-mpilo egazini. Ngemuva kwalokho ithumela igazi elinomoya-mpilo ngesifudumezi nesihlungi bese liyibuyisela emzimbeni.

Kunezinhlobo ezimbili ze-ECMO:

• i-veno-venous (VV) ECMO: I-VV ECMO ithatha igazi emthanjeni ilibuyisele emthanjeni. Lolu hlobo lwe-ECMO lusekela umsebenzi wamaphaphu.
• i-veno-arterial (VA) ECMO: I-VA ECMO ithatha igazi emthanjeni ilibuyisele emthanjeni. I-VA ECMO isekela kokubili inhliziyo namaphaphu. Iyahlasela kakhulu kune-VV ECMO. Kwesinye isikhathi umthambo we-carotid (umthambo omkhulu osuka enhliziyweni uye ebuchosheni) ungadinga ukuvalwa ngemuva kwalokho.

Ngiyilungiselela kanjani i-ECMO?

Udokotela uzohlola umuntu ngaphambi kwe-ECMO. I-cranial ultrasound izoqinisekisa ukuthi akukho ukopha ebuchosheni. I-cardiac ultrasound izonquma ukuthi inhliziyo iyasebenza yini. Futhi, ngenkathi uku-ECMO, uzoba ne-X-ray yesifuba nsuku zonke.

Ngemuva kokuthola ukuthi i-ECMO iyadingeka, odokotela bazolungisa imishini. Ithimba le-ECMO elizinikele, kufaka phakathi udokotela oqinisekiswe ngamabhodi oqeqeshiwe nolwazi ku-ECMO uzokwenza i-ECMO. Ithimba lifaka futhi:

• Abahlengikazi ababhalisiwe be-ICU
• abelaphi bokuphefumula
• ama-perfusionists (ongoti ekusetshenzisweni kwemishini yenhliziyo namaphaphu)
• abasebenzi bezokweseka nababonisi
• ithimba lezokuthutha elingu-24/7
• Ochwepheshe be-rehab

Kwenzekani ngesikhathi se-ECMO?

Ngokuya ngeminyaka yakho, odokotela abahlinzayo bazobeka futhi bavikele i-cannulae entanyeni, emgodini, noma esifubeni ngenkathi ungaphansi kwe-anesthesia ejwayelekile. Imvamisa uzohlala uthambile ngenkathi uku-ECMO.

I-ECMO ithatha umsebenzi wenhliziyo noma wamaphaphu. Odokotela bazokwenza ukuqapha okuseduze ngesikhathi se-ECMO ngokuthatha ama-X-ray nsuku zonke nokuqapha:

• isilinganiso senhliziyo
• izinga lokuphefumula
• amazinga e-oxygen
• ukushaya kwegazi

Ishubhu lokuphefumula nomoya ophefumulayo ugcina amaphaphu esebenza futhi usize ekususeni uketshezi.

Imithi izodlulisa ngokuqhubekayo ngamakhetha afakwa emithanjeni. Umuthi owodwa obalulekile yi-heparin. Lokhu kuncipha kwegazi kuvimbela ukujiya njengoba igazi lihamba ngaphakathi kwe-ECMO.

Ungahlala ku-ECMO noma yikuphi kusuka ezinsukwini ezintathu kuya enyangeni. Uma uhlala isikhathi eside ku-ECMO, kukhuphuka ubungozi bezinkinga.

Yiziphi izinkinga ezihambisana ne-ECMO?

Ingozi enkulu evela ku-ECMO ukuphuma kwegazi. I-heparin inciphisa igazi ukuvimbela ukuqina. Futhi kwandisa ingozi yokopha emzimbeni nasengqondweni. Iziguli ze-ECMO kumele zithole ukuhlolwa njalo kwezinkinga zokopha.

Kukhona nengozi yokutheleleka ekufakweni kwe-cannulae. Abantu abaku-ECMO cishe bazothola ukumpontshelwa igazi njalo. Lokhu futhi kunengozi encane yokutheleleka.

Ukungasebenzi kahle noma ukwehluleka kwemishini ye-ECMO kungenye ingozi. Ithimba le-ECMO liyazi ukuthi lingenza kanjani ezimweni eziphuthumayo njengokuhluleka kwe-ECMO.

Kwenzekani ngemuva kwe-ECMO?

Njengoba umuntu ethuthuka, odokotela bazobakhipha kwi-ECMO ngokunciphisa kancane kancane inani legazi elinomoya-mpilo nge-ECMO. Lapho nje umuntu ehla ku-ECMO, uzohlala kumshini wokuphefumula isikhathi esithile.

Labo abebekwi-ECMO basazodinga ukulandelelwa okuseduze ngesimo sabo esingaphansi.