He aha te Extracorporeal Membrane Oxygenation (ECMO)? Te Whāinga, te Hātepe me ngā Hua

Ko te Extracorporeal membrane oxygenation, arā ko ECMO, he mīhini tautoko-ora e whakakapi ana i te mahi o tō ngākau me ō pūkahukahu mō tētahi wā, inā he nui rawa te mate e kore ai e pai te mahi. Whakaarohia me te mea e whai wāhi ana ō pūkahukahu me ō ngākau ki te okioki me te whakaora i a rātou anō, i te wā e pupuri ana tētahi pūrere motuhake i te hāora e rere ana i tō tinana.

Nā tēnei hangarau rongoā matatau i āwhina ngā mano o ngā tāngata ki te ora i ngā mate tino nui, i te mea pea ka mate rātou. Ahakoa e rāhui ana te ECMO mō ngā tūāhuatanga tino nui, mā te māramatanga ki te pēhea te mahi ka āwhina i a koe kia mōhio ake mēnā e hiahia ana koe, tētahi rānei e arohaina ana e koe, ki tēnei maimoatanga.

He aha te ECMO?

He mīhini te ECMO e mahi ana me te pūnaha ngākau me te pūkahukahu horihori i waho o tō tinana. Ka tango i te toto i tō tinana, ka tāpiri i te hāora ki roto, ka tango i te hauhā, ā, ka pōmpa te toto hou i te hāora ki tō rerenga toto.

Ka mahi te pūnaha mā ngā ngongo e kīia ana ko ngā cannulas e whakanohohia ana i roto i ngā oko toto nui mā te pokanga. Ka haere tō toto mā ēnei ngongo ki te mīhini ECMO, i reira ka haere i runga i tētahi membrane motuhake e mahi ana i te whakawhiti hau e whakahaerehia ana e ō pūkahukahu. I tēnā wā, ka mahi tētahi pōmpa i te mahi e mahia ana e tō ngākau.

E rua ngā momo tautoko ECMO. Ka āwhina te Veno-venous (VV) ECMO i te wā e kore e mahi ana ō pūkahukahu engari e kaha tonu ana tō ngākau. Ka tautoko te Veno-arterial (VA) ECMO i tō ngākau me ō pūkahukahu i te wā e hiahia ana ngā okana e rua ki te āwhina.

He aha te take e mahia ana te ECMO?

Ka whakamahia te ECMO i te wā e tino nui ana te kino o tō ngākau, ō pūkahukahu rānei, e kore ai e taea e rātou te pupuri i a koe kia ora anō, ahakoa me ētahi atu maimoatanga. Ko te tikanga ka whakaarohia i te wā e kore e nui ngā rongoā pērā i ngā pūwero me ngā rongoā hei pupuri i ngā taumata hāora haumaru i roto i tō toto.

Ka tūtohu pea tō rōpū hauora ki te ECMO mēnā he nui te pūkahukahu, ngā raruraru COVID-19, te mate uaua manawa rānei (ARDS) kāore e aro ana ki te tautoko mōrahi o te hauora. Ka taea e ēnei āhuatanga te mumura me te kino o ō pūkahukahu, kāore e taea te whakawhiti i te hāora ki roto i ō toto.

Mō ngā raruraru e pā ana ki te ngākau, ka hiahiatia pea te ECMO i te wā o te whakaeke ngākau nui, te ngoikore ngākau nui, i muri rānei i ētahi pokanga ngākau i te wā e ngoikore ana te uaua ngākau ki te pōpō i te toto. Ka taea hoki te whakamahi hei rongoā piriti i te wā e tatari ana koe mō te whakawhitinga ngākau.

I ētahi wā ka whakamahia te ECMO i te wā o te hopu ngākau kāore i whakahokia mai te mahi ngākau noa e ngā mahi whakaora. I ēnei wā, ka taea e te mīhini te pupuri i te tohanga i te wā e mahi ana ngā tākuta ki te whakatika i te raruraru i puta ai te hopu.

He aha te tikanga mō te ECMO?

Ka tīmata te tikanga ECMO mā te whakatakoto i a koe e tō rōpū hauora i raro i te rongoā whānui, te rongoā rānei. Ka whakauru te tākuta pokanga, te tākuta rānei i whakangungua motuhake i ngā cannulas ki roto i ngā oko toto nui, te nuinga i tō kaki, tō waewae, tō uma rānei.

Mō te VV ECMO, te nuinga o ngā tākuta ka whakatakoto i tētahi cannula nui ki roto i te uaua i tō kaki, tō waewae rānei. Ka taea e tēnei cannula kotahi te tango i te toto i tō tinana me te whakahoki i te toto hāora, ahakoa i ētahi wā e rua ngā cannulas motuhake e whakamahia ana.

E hiahia ana te VA ECMO ki te whakatakoto i ngā cannulas ki roto i te uaua me te uaua. Ka tango te cannula venous i te toto i tō tinana, i te wā e whakahoki ana te cannula arterial i te toto hāora ki tō tohanga arterial, e karo ana i tō ngākau katoa.

Kia noho ngā cannulas, ka hono tō rōpū hauora ki te ara ECMO. Kei roto i te pūnaha he pōpō, he oxygenator (pūkahukahu horihori), me ngā taputapu aroturuki rerekē. Ka hoatu te rongoā whakaheke toto hei aukati i te hanga o ngā kōpuku i roto i te ara.

I te wā o te mahi, ka aroturukihia tonutia ō tohu nui. Ko te katoa o te whakarite ka kotahi ki te rua haora te roa, i runga i te uaua o tō āhua me te momo tautoko ECMO e hiahia ana koe.

Me pēhea te whakarite mō te ECMO?

He tata tonu te ECMO he rongoā ohorere, nō reira kāore he wā mō te whakarite tikanga. Heoi, ki te whakaarohia koe mō te ECMO, ka tere te aromatawai a tō rōpū hauora mō te pai o tō tūnga mō tēnei rongoā kaha.

Ka arotakehia e ō tākuta tō hītori hauora, ngā rongoā e inu ana koe, me te āhua o tō hauora. Ka mahia hoki e rātou ngā whakamātautau toto hei tirotiro i tō mahi whakaheke toto, te mahi o te pūkahukahu, me ētahi atu āhuatanga nui e pā ana ki te pai o tō whakamanawa i te ECMO.

Mēnā kei te mōhiō koe, ka whakamāramahia e tō rōpū hauora te mahi me ōna tūponotanga ki a koe, ki ō whānau rānei. Ka kōrerohia e rātou ngā rongoā kē atu, ā, ka āwhina i a koe ki te mārama he aha te take e tūtohu ana te ECMO i tō āhuatanga motuhake.

Ka whakarite hoki tō rōpū manaaki kia nui ō uru IV, ā, ka waiho pea ētahi atu pūrere aroturuki pēnei i ngā rārangi ā-arterial hei aroturuki tonu i tō pēhanga toto. Ki te kāore anō koe i runga i te hauora, ka waiho pea tētahi hei āwhina i te tiaki i tō ara rererangi i te wā o te mahi.

Me pēhea te pānui i ō hua ECMO?

Kāore te ECMO e whakaputa hua whakamātautau i te tikanga tuku iho, engari ka aroturukihia tonutia e tō rōpū hauora ētahi tau nui hei whakarite kei te pai te mahi o te pūnaha. Ko ēnei ine e whakaatu ana ki ngā tākuta te pai o te tautoko a te mīhini i ngā hiahia o tō tinana.

Ka inea ngā reiti rere toto i roto i ngā rita ia meneti, ā, e whakaatu ana i te nui o te toto e neke ana i roto i te ara ECMO. Ko te tikanga, ko ngā reiti rere teitei ake te tikanga he nui ake te tautoko, engari ko ngā tau tika e whakawhirinaki ana ki te rahi o tō tinana me te āhua hauora.

Ka aroturukihia ngā taumata hāora i roto i ō toto mā te ine hau toto i ngā wā katoa. E rapu ana tō rōpū i ngā taumata whakakī hāora i runga ake i te 88-90% me ngā taumata hauhā i roto i te awhe noa, e tohu ana kei te pai te mahi o te pūkahukahu horihori.

E aroturukihia ana hoki e tō rōpū hauora ngā tere o te pūmua, e inea ana i roto i ngā hurihanga ia meneti (RPM). Ka whakatikahia ēnei tere i runga i te nui o te tautoko e hiahiatia ana e tō ngākau me ō pūkahukahu i te wā e huri ana tō āhua.

Ka mahia ngā whakamātautau taiwhanga i ngā wā katoa hei tirotiro mō ngā tohu o te toto, te pūpū, te mahi tākihi, me ētahi atu raruraru. Ka whakamahia e ō tākuta ēnei ine katoa hei whakatika i ō tautuhinga ECMO me te whakamahere i tō maimoatanga whānui.

Me pēhea te arotau i tō tautoko ECMO?

I te wā e noho ana koe i runga i te ECMO, ka mahi tonu tō rōpū hauora ki te arotau i te tautoko e whiwhi ana koe. Kei roto i tēnei ko te taurite i ngā tautuhinga o te mīhini me ngā hiahia huri haere o tō tinana i te wā e pai ake ana, e kino ake ana rānei tō āhua.

Ka whakatikahia e ō tākuta ngā reiti rere toto me ngā taumata hāora i runga i ō hua taiwhanga me te āhua haumanu. Ka piki ake pea te tautoko mēnā e hiahia ana ō rārangi ki te āwhina nui ake, ka whakaheke haere rānei i te wā e tīmata ana tō ngākau me ō pūkahukahu ki te ora.

Ko te ārai i ngā raruraru he wāhanga nui o te whakahaere ECMO. E aroturukihia ana koe e tō rōpū mō te toto, te pūpū, me te mate. Ka whakatikahia e rātou ō rongoā whakaheke toto, ā, ka mahia pea ngā tikanga hei whakatika i ngā take ka puta.

He maha ngā wā ka tīmata te rongoā tinana i te wā e noho ana koe i runga i te ECMO, ahakoa kei te rongoā koe. Ka āwhina tēnei ki te ārai i te ngoikore o te uaua me te pūpū toto. Ka mahi tahi hoki tō rongoā manawa me ō pūkahukahu ki te whakatairanga i te whakaora me te ārai i te kino atu.

Ko te whāinga ko te wehe i a koe i te tautoko ECMO i te tere me te haumaru ka taea. Ka whakaheke haere tō rōpū hauora i te āwhina o te mīhini i te wā e ora ana tō ngākau me ō pūkahukahu.

He aha ngā āhuatanga mōrearea mō te hiahia ECMO?

He maha ngā āhuatanga hauora ka piki ake te tūponotanga ka hiahia koe ki te tautoko ECMO. Mā te māramatanga ki ēnei āhuatanga tūpono ka āwhina koe ki te mōhio ki te wā ka tūpono ake te tangata ki ngā raruraru ngakau, pūkahukahu rānei.

Ngā āhuatanga manawa nui pea ka ahu ki te ECMO:

• Te pūkahukahu nui e kore e aro ki ngā paturopi me te tautoko hau
• COVID-19 me ngā raruraru pūkahukahu nui
• Te mate uaua manawa (ARDS) mai i ngā momo take rerekē
• Ngā whakaeke huango nui e kore e aro ki te rongoā nui rawa
• Te ruku, te whara rānei i te auahi

Ka taea e ēnei āhuatanga te whara i te pūkahukahu, kāore e taea e ngā hau nui te pupuri i ngā taumata hāora tika i roto i tō toto.

Ngā āhuatanga e pā ana ki te ngakau pea ka hiahia tautoko ECMO:

• Ngā whakaeke ngakau nui e whara ana i ngā wāhi nui o te uaua ngakau
• Te ngoikore ngakau nui e kore e aro ki ngā rongoā
• Ngā raruraru i muri i te pokanga ngakau
• Te ohorere cardiogenic kāore e taea e te ngakau te pūhi i te toto nui
• Ngā raruraru manawa ngakau nui e pā ana ki te hopu ngakau

Ka taea hoki e ētahi āhuatanga o te tūroro te whakanui i te tūponotanga ECMO, tae atu ki te pakeke, te maha o ngā āhuatanga hauora mau tonu, me te mate ngakau, pūkahukahu rānei o mua. Heoi, ka whakatauhia ngā whakatau ECMO i runga i tō āhuatanga takitahi, kaua ko ēnei āhuatanga tūpono whānui anake.

He pai ake te ECMO mō te tautoko ngakau, mō te tautoko pūkahukahu rānei?

Ka taea e te ECMO te tautoko i te mahi ngakau me te mahi pūkahukahu, engari kei te whakawhirinaki te momo tautoko ki ngā okana e hiahia ana ki te āwhina. I hangaia te VV ECMO mō te tautoko pūkahukahu, i te wā e taea ana e te VA ECMO te tautoko i te mahi ngakau me te mahi pūkahukahu i te wā kotahi.

Mō ngā raruraru pūkahukahu anake, he pai ake te VV ECMO nā te mea ka taea e tō ngākau te mahi tonu i te wā e whai wāhi ana ō pūkahukahu ki te whakaora. Mā tēnei huarahi e tiaki te mahi tūturu o tō ngākau, ā, ka pai ake pea ngā hua i te wā roa.

Ki te kore e pai tō ngākau, ka nui ake te tautoko a VA ECMO mā te whakahaere i ngā mahi pūngao me te oxygenation. Mā tēnei e whai wāhi ai tō ngākau me ō pūkahukahu ki te whakaora i te āhuatanga i puta ai te raru.

Ko te whiriwhiri i waenga i ngā momo ECMO e whakawhirinaki ana ki tō āhuatanga hauora, te pai o te mahi o tō ngākau, me tō āhua hauora whānui. Mā tō rōpū hauora e whiriwhiri te huarahi e pai ai te tūponotanga o te whakaora.

He aha ngā raruraru ka puta mai i te ECMO?

Ahakoa ka taea e te ECMO te whakaora i te ora, he nui ngā tūponotanga e pā ana, ā, ka mātakitaki pūmau tō rōpū hauora. Mā te māramatanga ki ēnei raruraru ka āwhina i a koe me tō whānau ki te mōhio ki ngā mea e tūmanakohia ana i te wā o te rongoā.

Ko te toto te raruraru tino noa, nā te mea me whakamahi rongoā whakaheke toto i te ECMO hei ārai i ngā kōpuku i roto i te ara iahiko. Ka puta tēnei i te toto i ngā wāhi o te cannula, i tō roro, i ētahi atu wāhi o tō tinana.

Ka taea e ngā kōpuku toto te hanga ahakoa te whakamahi rongoā whakaheke toto, ka aukati pea i te rere o te toto ki ngā okana nui. Ka whakahaere tō rōpū hauora i ngā whakamātautau auau hei taurite i te tūponotanga o te toto ki te tūponotanga o te kōpuku.

Ko te mate urutā tētahi atu āwangawanga nui, ina koa i ngā wāhi whakauru cannula, i roto rānei i tō rerenga toto. I te roa o tō noho i runga i te ECMO, ka nui ake tēnei tūponotanga, koia te take e mahi ana ngā tākuta ki te tango i a koe i te tautoko i te wa e taea ai.

Ka taea e ngā raruraru tākihi te puta mai nā te pēhanga o te mate nui me te tikanga ECMO tonu. Ētahi tūroro ka hiahia pea ki te dialysis rangitahi hei tautoko i te mahi o ō rātou tākihi i te wā o te whakaora.

Ngā raruraru kāore i te noa engari he nui:

• Te whiu mai i ngā pūpū toto, i te rerenga toto rānei i roto i te roro
• Te kino ki ngā oko toto mai i ngā kānaura
• Ngā raruraru ki te ara iahiko ECMO e hiahia ana kia whakatikahia ohorere
• Ngā raruraru mai i te rongoā roa me te kore neke

E aroturukihia ana koe e tō rōpū hauora mō ēnei raruraru, ā, he tikanga ā rātou hei whakahaere wawe i a rātou mēnā ka puta.

Āhea au e kite ai i te tākuta mō te ECMO?

Ko te tikanga ka tīmata te ECMO i ngā hōhipera i ngā wā ohorere hauora, nō reira kāore te whakatau i te mea e whakatau ana koe anake. Heoi anō, he wāhi ka hiahia koe ki te kōrero mō te ECMO ki ō kaiwhakarato hauora.

Mēnā he mate nui tō ngākau, tō pūkahukahu rānei, tērā pea ka hiahia koe ki te pātai ki tō tākuta mō te ECMO hei whiringa rongoā i te wā o te ohorere nui. Mā tēnei kōrero e āwhina i a koe ki te mārama mēnā he kaitono koe mō tēnei rongoā.

Me whakawhitiwhiti kōrero tonu ngā whānau o ngā tūroro e whakamahi ana i te ECMO ki te rōpū hauora mō ngā whāinga o te manaaki, ngā tohu o te ahunga whakamua, me ngā tūmanako tūturu mō te whakaora. Mā ēnei kōrero e āwhina kia mārama te katoa ki te mahere rongoā.

Mēnā kei te whakaaro koe ki te ECMO hei piriti ki te whakawhitinga ngākau, pūkahukahu rānei, kōrerohia tēnei whiringa ki tō rōpū whakawhiti wawe i tō manaaki. Mā rātou e āwhina i a koe ki te mārama me pēhea te ECMO e uru ai ki tō rautaki rongoā whānui.

Mō ngā tūroro he tohutohu whakamua, he mea nui kia kōrero koe i ō hiahia mō ngā rongoā kaha pēnei i te ECMO ki ō kaiwhakarato hauora me ngā mema o te whānau i mua i te ohorere.

Ngā pātai e pātai pinepine ana mō te ECMO

Q.1 He pai te whakamātautau ECMO mō te korenga o te ngākau?

Ehara te ECMO i te whakamātautau – he rongoā e āhei ana te tautoko i te oranga mō te ngoikore o te ngākau nui, ina kore e whai hua ētahi atu rongoā. Ka taea e te VA ECMO te whakahaere i te mahi papu o tō ngākau, e whai wā ai te uaua o tō ngākau ki te ora, ki te mahi rānei hei piriti ki te whakawhitinga ngākau. Heoi anō, ka whakamahia anake i ngā take tino nui, ina kore e taea e tō ngākau te pupuri i te tohanga ahakoa te rongoā mōrahi.

Q.2 He raruraru ka pā mai i te ECMO?

Āe, ka pā mai i te ECMO ētahi raruraru, tae atu ki te toto, te pūhui toto, te mate, me ngā raruraru o te pūkahukahu. Ka piki ake te tūponotanga o ngā raruraru i te roa o te rongoā, koinei te take e mahi tahi ana tō rōpū hauora ki te whakawātea i a koe i te tautoko ECMO i te wa e taea ai. Ahakoa ēnei tūponotanga, ka taea e te ECMO te whakaora i te hunga e tino ngoikore ana te ngākau, te pūkahukahu rānei, e kore e ora me te kore tēnei tautoko.

Q.3 Kia pēhea te roa e noho ai te tangata i runga i te ECMO?

He rerekē te roa o te tautoko ECMO i runga i tō āhuatanga me te tere o te ora o ō rātou okana. Ko ētahi tāngata e hiahia ana ki te tautoko mō ētahi rā noa iho, i ētahi atu rānei e hiahiatia ana kia maha ngā wiki, marama rānei. I te nuinga, ko ngā wā poto e hono ana ki ngā hua pai ake, nō reira ka mahi tahi tō rōpū hauora ki te whakaiti i te wā e noho ana koe i runga i te ECMO i te wa e whakarite ana i te wā tika mō te ora o ō okana.

Q.4 Ka taea e koe te ora i te ECMO?

Āe, he maha ngā tāngata e ora ana i te rongoā ECMO, ā, ka whai oranga pai. Kei te whakawhirinaki ngā reiti oranga ki ngā āhuatanga pēnei i tō tau, ngā āhuatanga hauora, me te take i hiahia ai koe ki te tautoko ECMO. Ko ngā tāngata e raru ana i te pūkahukahu te nuinga o te wā he reiti oranga teitei ake i te hunga e raru ana i te ngākau, ā, ko ngā tāngata tamariki te nuinga o te wā ka pai ake i ngā tāngata pakeke. Ka taea e tō rōpū hauora te whakarato i ētahi atu mōhiohio motuhake mō tō matapae takitahi.

Q.5 He mamae te ECMO?

Ko te nuinga o ngā tūroro e noho ana i runga i te ECMO ka whiwhi rongoā whakamaarama me te rongoā mamae kia pai ai te noho i te wā e rongoā ana. Ka mahia te tikanga whakauru cannula i raro i te rongoā whakamoe, nā reira e kore koe e rongo i te mamae i te wā e whakanohohia ana. I te wā e noho ana koe i runga i te ECMO, ka āta whakahaere tō rōpū hauora i ō taumata whakamarie me te whakatika i ngā rongoā ina hiahiatia kia mōhio ai koe kāore koe e rongo ana i te mamae nui.