Ni iki cyitwa Extracorporeal Membrane Oxygenation (ECMO)? Impamvu, Uburyo & Ibivamo

Extracorporeal membrane oxygenation, cyangwa ECMO, ni imashini ifasha kubaho by'agateganyo ifata akazi k'umutima wawe n'ibihaha byawe igihe barwaye cyane ku buryo batagishoboye gukora neza. Utekereze nk'uko uha ibice by'ingenzi by'umubiri wawe amahirwe yo kuruhuka no gukira mugihe igikoresho cyihariye gikomeza gutuma umwuka wa oxygen ukwirakwira mumubiri wawe.

Ubu buhanga buhanitse bwa tekiniki y'ubuvuzi bwafashije ibihumbi by'abantu kurokoka indwara zikomeye zishobora kuba zica. Nubwo ECMO yagenewe ibibazo bikomeye cyane, gusobanukirwa uko ikora birashobora kugufasha kumva ufite amakuru menshi niba wowe cyangwa uwo ukunda yigeze akeneye ubu buvuzi.

ECMO ni iki?

ECMO ni imashini ikora nk'umutima w'ubwenge n'ibihaha hanze y'umubiri wawe. Ikura amaraso mu mubiri wawe, ikongeramo oxygen, ikura karuboni diokiside, hanyuma igasubiza amaraso mashya ya oxygen mu maraso yawe.

Ubu buryo bukoresha imiyoboro yitwa cannulas ishyirwa muburyo bwo kubaga mumitsi minini y'amaraso. Amaraso yawe anyura muri iyi miyoboro ajya muri mashini ya ECMO, aho anyura kuri membrane yihariye ikora guhanahana gazi ibihaha byawe bisanzwe bikora. Hagati aho, pompe ikora akazi umutima wawe usanzwe ukora.

Hariho ubwoko bubiri bw'ingenzi bwa ECMO. Veno-venous (VV) ECMO ifasha igihe ibihaha byawe bidakora ariko umutima wawe ukiri muzima. Veno-arterial (VA) ECMO ifasha umutima wawe n'ibihaha byawe igihe ibice byombi bikeneye ubufasha.

Kuki ECMO ikorwa?

ECMO ikoreshwa igihe umutima wawe cyangwa ibihaha byawe byangiritse cyane ku buryo bitashobora kugufasha kubaho wenyine, kabone niyo hakoreshejwe izindi nshuti. Muri rusange, bitekerezwa igihe ubuvuzi busanzwe nka ventilateurs n'imiti bidahagije kugirango bigumane urwego rwa oxygen ruzima mumaraso yawe.

Itsinda ryawe ry'abaganga rishobora kugusaba ECMO niba ufite umusonga ukabije, ibibazo bya COVID-19, cyangwa indwara ya respiratory distress syndrome (ARDS) idasubiza ku nkunga ya ventilateur. Ibi bibazo bishobora gutuma amabuye yawe abyimba cyane kandi yangirika ku buryo adashobora kwinjiza umwuka wa oxygen mu maraso yawe neza.

Ku bibazo bifitanye isano n'umutima, ECMO ishobora gukenerwa mugihe cyo gufatwa n'umutima ukabije, kunanirwa k'umutima ukabije, cyangwa nyuma yo kubagwa umutima runaka mugihe imitsi y'umutima wawe itameze neza gukora neza. Irashobora kandi gukora nk'ubuvuzi bwo gukora umurimo mugihe utegereje kwimura umutima.

Rimwe na rimwe ECMO ikoreshwa mugihe cyo guhagarara k'umutima mugihe imbaraga zisanzwe zo kuzahura zitagaruye imikorere isanzwe y'umutima. Muri ibi bihe, imashini irashobora gukomeza kuzenguruka mugihe abaganga bakora kugirango bakemure ikibazo cyateye guhagarara.

Ni iki gikorerwa ECMO?

Uburyo bwa ECMO butangirana n'itsinda ryawe ry'abaganga bakugira munsi ya anesthesia rusange cyangwa gutuza cyane. Umuganga ubaga cyangwa umuganga wihariye watojwe azashyira cannulas mu mitsi minini y'amaraso, akenshi mu ijosi ryawe, mu gatuza, cyangwa mu gatuza.

Kubera VV ECMO, abaganga basanzwe bashyira cannula nini imwe mu mujyana wo mu ijosi ryawe cyangwa mu gatuza. Iyi cannula imwe irashobora gukuraho amaraso mu mubiri wawe no gusubiza amaraso ya oxygen, nubwo rimwe na rimwe hakoreshwa cannulas ebyiri zitandukanye.

VA ECMO bisaba gushyira cannulas mu mitsi y'amaraso no mu mujyana. Cannula ya venous ikuraho amaraso mu mubiri wawe, mugihe cannula ya arterial isubiza amaraso ya oxygen mu maraso yawe ya arterial, yirengagiza umutima wawe rwose.

Iyo cannulas zimaze gushyirwa, itsinda ryawe ry'abaganga rirazihuza na ECMO. Sisitemu irimo pompe, oxygenator (igihaha cy'ubukorano), n'ibikoresho bitandukanye byo gukurikirana. Imiti ituma amaraso atavura itangwa kugirango yirinde ko ibyuririzi bishobora gukorwa muri sisitemu.

Mugihe cyose cyo kuvurwa, ibimenyetso byawe by'ingenzi bikurikiranwa buri gihe. Uburyo bwose bwo gutegura busanzwe bufata isaha imwe cyangwa ebyiri, bitewe n'uburyo uburwayi bwawe bumeze n'ubwoko bwa ECMO ukeneye.

Ni gute witegura ECMO?

ECMO hafi ya hose ni ubuvuzi bwihutirwa, bityo akenshi nta mwanya wo kwitegura gakondo. Ariko, niba utekerezwa kuri ECMO, itsinda ryawe ry'abaganga rizasuzuma vuba niba uri umukandida mwiza kuri ubu buvuzi bukomeye.

Abaganga bawe bazasuzuma amateka yawe y'ubuvuzi, imiti ukoresha ubu, n'ubuzima bwawe muri rusange. Bazanakora ibizamini by'amaraso kugirango barebe imikorere yawe yo gupfuka, imikorere y'impyiko, n'ibindi bintu by'ingenzi bigira uruhare mu buryo wihanganira ECMO.

Niba wumva, itsinda ryawe ry'abaganga rizasobanura uburyo bwo kuvurwa n'ingaruka zaryo kuri wowe cyangwa ku bagize umuryango wawe. Bazaganira ku buvuzi bundi kandi bagufashe gusobanukirwa impamvu ECMO isabwa mu bihe byawe byihariye.

Itsinda ryawe ryita ku buzima rizanasuzuma ko ufite uburyo buhagije bwo gushyiraho IV kandi rishobora gushyiraho ibindi bikoresho byo gukurikirana nka mirongo ya arteri kugirango bakurikirane umuvuduko w'amaraso yawe buri gihe. Niba utarimo kuri ventilateur, rimwe rishobora gushyirwaho kugirango rifashe kurengera inzira yawe yo guhumeka mugihe cyo kuvurwa.

Ni gute usoma ibisubizo byawe bya ECMO?

ECMO ntisohora ibisubizo by'ibizamini mu buryo gakondo, ariko itsinda ryawe ry'abaganga rikomeza gukurikirana imibare myinshi y'ingenzi kugirango rimenye neza ko sisitemu ikora neza. Ibi bipimo bibwira abaganga uburyo imashini ifasha umubiri wawe.

Umuvuduko w'amaraso upimwa muri litiro ku munota kandi werekana amaraso angana iki anyura muri ECMO. Umuvuduko mwinshi muri rusange uvuze inkunga nyinshi, ariko imibare nyayo iterwa n'ubunini bw'umubiri wawe n'uburwayi bwawe.

Ubukana bwa ogisijeni mu maraso yawe bugenzurwa binyuze mu bipimo bya gaze y'amaraso bihoraho. Itsinda ryawe rishakisha urwego rwa ogisijeni ruri hejuru ya 88-90% n'urwego rwa karuboni diyokiside ruri mu kigereranyo gisanzwe, ibyo bikerekana ko uruhara rw'ubwenge rukora neza.

Itsinda ryawe ry'abaganga riranagenzura umuvuduko wa pompe, upimwa mu mpinduka ku munota (RPMs). Uyu muvuduko uhindurwa hashingiwe ku buryo umutima wawe n'ibihaha byawe bikeneye ubufasha uko ubuzima bwawe buhinduka.

Ibipimo byo muri laboratori bikorwa kenshi kugira ngo barebe ibimenyetso by'amaraso ava, amaraso avura, imikorere y'impyiko, n'izindi ngorane. Abaganga bawe bakoresha ibipimo byose hamwe kugira ngo bahindure imiterere ya ECMO yawe kandi bategure imiti yawe yose.

Ni gute wakoresha neza ubufasha bwawe bwa ECMO?

Mugihe uri kuri ECMO, itsinda ryawe ry'abaganga rikora buri gihe kugira ngo rikoreshe neza ubufasha urimo urabona. Ibi bikubiyemo kuringaniza neza imiterere ya mashini n'ibyo umubiri wawe ukeneye uko ubuzima bwawe bwiyongera cyangwa bukazamba.

Abaganga bawe bazahindura umuvuduko w'amaraso n'urwego rwa ogisijeni hashingiwe ku ngaruka za laboratori yawe n'ubuzima bwawe bwa kliniki. Barashobora kongera ubufasha niba ingingo zawe zikeneye ubufasha bwinshi, cyangwa buhoro buhoro bakabugabanya uko umutima wawe n'ibihaha byawe bitangira gukira.

Gukumira ingorane ni igice cyingenzi cyo gucunga ECMO. Itsinda ryawe rigukurikiranira hafi amaraso ava, amaraso avura, n'indwara. Bazahindura imiti yawe igabanya amaraso kandi barashobora gukora ibikorwa byo gukemura ibibazo byose bivutse.

Imiti y'umubiri akenshi itangira mugihe uri kuri ECMO, kabone niyo waba warashyizwe mu kantu. Ibi bifasha gukumira intege nke z'imitsi n'amaraso avura. Umuganga wawe w'ubuhumekero azakorana n'ibihaha byawe kugira ngo ateze imbere gukira no gukumira ibindi byangiritse.

Intego ni ukugukuraho ubufasha bwa ECMO vuba kandi neza bishoboka. Itsinda ryawe ry'abaganga rizagabanya buhoro ubufasha bwa mashini uko umutima wawe n'ibihaha byawe bikira imikorere yabyo.

Ni ikihe kintu gishyira mu kaga ko gukenera ECMO?

Indwara nyinshi zishobora kongera amahirwe yo gukenera ubufasha bwa ECMO. Kumva ibi bintu bishobora gutuma umenya igihe umuntu ashobora kuba afite ibibazo bikomeye by'umutima cyangwa ibihaha.

Indwara zikomeye zo mu myanya y'ubuhumekero zishobora gutuma umuntu akeneye ECMO zirimo:

• Icyorezo gikomeye cyane cy'ibihaha kititabira imiti yica mikorobe n'ubufasha bwa ventilateur
• COVID-19 ifite ibibazo bikomeye by'ibihaha
• Uburwayi bukomeye bwo guhumeka (ARDS) buturutse ku mpamvu zitandukanye
• Ibitero bikomeye bya asima bititabira imiti ikoreshwa cyane
• Kurohama cyangwa gukomereka biturutse ku mwuka w'umwotsi

Izi ndwara zishobora gutera ibihaha kwangirika cyane ku buryo na ventilateurs zikoresha umuvuduko mwinshi zitashobora gukomeza urwego rwo hejuru rwa oxygen mu maraso yawe.

Indwara zifitanye isano n'umutima zishobora gukenera ubufasha bwa ECMO zirimo:

• Umutima utera cyane wangiza ibice binini by'imitsi y'umutima
• Kunanirwa gukora kw'umutima gukomeye kutitabira imiti
• Ibibazo nyuma yo kubagwa umutima
• Umutima utera cyane aho umutima udashobora kuvana amaraso ahagije
• Ibibazo bikomeye by'umuvuduko w'umutima bitera guhagarara k'umutima

Ibintu bimwe na bimwe by'umurwayi nabyo bishobora kongera ibyago bya ECMO, harimo imyaka y'ubukure, indwara nyinshi zidakira, n'indwara zabanje z'umutima cyangwa ibihaha. Ariko, ibyemezo bya ECMO bifatwa buri gihe hashingiwe ku miterere yawe bwite aho gushingira kuri ibi bintu rusange by'ibyago gusa.

Ese ECMO iruta mu gufasha umutima cyangwa ibihaha?

ECMO ishobora gufasha neza imikorere y'umutima n'ibihaha, ariko ubwoko bw'ubufasha buterwa n'ingingo zikeneye ubufasha. VV ECMO yagenewe by'umwihariko gufasha ibihaha, naho VA ECMO ishobora gufasha imikorere y'umutima n'ibihaha icyarimwe.

Ku bibazo by'umwuka gusa, VV ECMO akenshi irahabwa agaciro kuko yemerera umutima wawe gukomeza gukora bisanzwe mu gihe ihuha amashyi yawe igihe cyo gukira. Ubu buryo burinda imikorere isanzwe y'umutima wawe kandi bushobora gutuma habaho ibisubizo byiza by'igihe kirekire.

Iyo umutima wawe unanirwa, VA ECMO itanga ubufasha bwuzuye binyuze mu gufata imikorere yombi yo gutera no guhumeka. Ibi bitanga umutima wawe n'amashyi yawe amahirwe yo koroherwa n'icyo aricyo cyose cyateje icyorezo.

Guhitamo hagati y'ubwoko bwa ECMO biterwa n'uburwayi bwawe bwihariye, uko umutima wawe ukora neza, n'ubuzima bwawe muri rusange. Itsinda ryawe ry'abaganga rizagena uburyo buguha amahirwe meza yo gukira.

Ni izihe ngaruka zishobora guterwa na ECMO?

Mugihe ECMO ishobora kurokora ubuzima, ifite ibyago bikomeye itsinda ryawe ry'abaganga rizakurikirana neza. Kumva izi ngaruka zishobora gutuma wowe n'umuryango wawe mumenya icyo mwitegura mugihe cyo kuvurwa.

Kuva amaraso ni imwe mu ngaruka zisanzwe kuko ECMO isaba imiti igabanya amaraso kugirango yirinde ibibazo mu murongo. Ibi bishobora gutera kuva amaraso ahantu hashyizweho cannula, mu bwonko bwawe, cyangwa mu bindi bice by'umubiri wawe.

Uduce tw'amaraso dushobora gukora nubwo hakoreshwa imiti igabanya amaraso, ishobora guhagarika urujya n'uruza rw'amaraso mu ngingo z'ingenzi. Itsinda ryawe ry'abaganga rikora ibizamini bisanzwe kugirango bigereranye ibyago byo kuva amaraso n'ibyago byo gukora ibibazo.

Infesiyo ni ikindi kibazo gikomeye, cyane cyane ahantu hashyizweho cannula cyangwa mu maraso yawe. Igihe kirekire umaze kuri ECMO, ni ko ibi byago byiyongera, niyo mpamvu abaganga bakora kugirango bagukuraho ubufasha vuba bishoboka.

Ibibazo by'impyiko bishobora kuvuka bitewe n'umunaniro w'uburwayi bukomeye n'uburyo bwa ECMO ubwabwo. Abantu bamwe barashobora gukenera dialysis y'agateganyo kugirango bashyigikire imikorere y'impyiko zabo mugihe cyo gukira.

Ingaruka zitazwi cyane ariko zikomeye zirimo:

• Uburwayi bwatewe n’amaraso yazibye cyangwa kuva amaraso mu bwonko
• Ukwangirika kw’imitsi y’amaraso biturutse ku byuma byashyizwemo
• Ibibazo byatewe n’imikorere y’imashini ya ECMO bisaba gukorwa vuba
• Ingaruka ziterwa no guhagarika umubiri igihe kirekire no kutagira icyo ukora

Itsinda ry’abaganga bakurikirana imiterere yawe buri gihe kugira ngo bamenye izo ngaruka kandi bafite uburyo bwo kuzikemura vuba mu gihe zigaragaye.

Ni ryari nkwiriye kubona umuganga ku bijyanye na ECMO?

ECMO akenshi itangirwa mu bitaro mu gihe cy’uburwayi bwihutirwa, bityo icyemezo akenshi nticyifatirwa wenyine. Ariko, hariho ibihe ushobora kwifuza kuganira na muganga wawe ku bijyanye na ECMO.

Niba ufite indwara ikomeye y’umutima cyangwa y’ibihaha, ushobora kwifuza kubaza muganga wawe kuri ECMO nk'uburyo bwo kuvura bushoboka mu gihe uburwayi bwiyongereye. Iyo ganira irashobora kugufasha gusobanukirwa niba waba ukwiriye guhabwa ubu buvuzi.

Imiryango y’abarwayi bari kuri ECMO bakwiriye kugirana ibiganiro bihoraho n’itsinda ry’abaganga ku ntego z’ubuvuzi, ibimenyetso by’iterambere, n’ibyiringiro byo gukira bifatika. Izo ngingo zifasha kumenya neza ko buri wese asobanukirwa gahunda y’ubuvuzi.

Niba utekereza kuri ECMO nk'ikiraro cyo kujya mu mutima cyangwa mu bihaha byatewe, ganira kuri icyo gitekerezo n’itsinda ryawe ryo kwimura ibice by’umubiri hakiri kare mu buvuzi bwawe. Bashobora kugufasha gusobanukirwa uburyo ECMO yakwinjira muri gahunda yawe y’ubuvuzi muri rusange.

Ku barwayi bafite amabwiriza mbere y’igihe, ni ngombwa kuganira ku byo ukunda ku bijyanye n’ubuvuzi bukomeye nka ECMO n’abaganga bawe ndetse n’abagize umuryango mbere y’uko ikibazo kiba.

Ibice bibazwa kenshi kuri ECMO

Q.1 Ese ikizamini cya ECMO ni cyiza ku guhagarara k'umutima?

ECMO si ikizamini - ni uburyo bwo kuvura bushobora gutanga ubufasha burokorera ubuzima mu gihe umutima wanze gukora neza cyane iyo ubundi buryo bwo kuvura butagikora. VA ECMO ishobora gusimbura imikorere yo gutera umutima, igaha umutsi w'umutima wawe umwanya wo gukira cyangwa ikaba nk'ikiraro kugeza igihe cyo guhindurirwa umutima. Ariko, ikoreshwa gusa mu gihe kitoroshye cyane aho umutima wawe udashobora gukomeza gutera nubwo wakoresha imiti yose ishoboka.

Q.2 Ese ECMO itera ingorane?

Yego, ECMO ishobora gutera ingorane nyinshi zirimo kuva amaraso, ibibumbe by'amaraso, indwara zandura, n'ibibazo by'impyiko. Ibyago by'ingorane byiyongera iyo umuntu amaze igihe kinini avurwa, ni yo mpamvu ikipe yawe y'abaganga ikora kugira ngo igukurure kuri ECMO vuba na bwangu uko bishoboka. Nubwo hari izi ngorane, ECMO ishobora kurokora ubuzima bw'abarwayi bafite umutima cyangwa ibihaha byanze gukora neza batashobora kubaho badafashijwe n'ubu buryo.

Q.3 Umuntu ashobora kumara igihe kingana iki kuri ECMO?

Igihe cyo gufashwa na ECMO gitandukana cyane bitewe n'uburwayi ufite n'uburyo ibice by'umubiri wawe bikira vuba. Abarwayi bamwe bakeneye ubufasha mu minsi mike gusa, mu gihe abandi bashobora gukenera ibyumweru byinshi cyangwa ndetse n'amezi. Muri rusange, igihe gito gihurirana n'imyitwarire myiza, bityo ikipe yawe y'abaganga izakora kugira ngo igabanye igihe umara kuri ECMO mu gihe yizera ko ibice by'umubiri wawe bifite umwanya uhagije wo gukira.

Q.4 Ese urashobora kurokoka ukoresheje ECMO?

Yego, abarwayi benshi barokoka bavurwa na ECMO kandi bakagira ubuzima bwiza. Urwego rwo kurokoka rugendera ku bintu nk'imyaka yawe, uburwayi ufite, n'impamvu wari ukeneye ubufasha bwa ECMO. Abarwayi bafite ibibazo by'ibihaha muri rusange bagira urwego rwo kurokoka ruri hejuru kurusha abafite ibibazo by'umutima, kandi abantu bakiri bato muri rusange babaho neza kurusha abageze mu zabukuru. Ikipe yawe y'abaganga ishobora gutanga amakuru arambuye ku birebana n'uburwayi bwawe bwihariye.

Q.5 Ese ECMO irababaza?

Abantu benshi barimo kuvurwa na ECMO bahabwa imiti igabanya ububabare n'ibitotsi kugira ngo baruhuke mu gihe bavurwa. Uburyo bwo gushyira imitsi (cannula) mu mubiri bukorwa umuntu atazi ibibera (anesthesia), bityo ntuzumva ububabare igihe barimo kuyishyira. Igihe uri kuri ECMO, itsinda ry'abaganga bakurikirana neza uko wumva umeze kandi bagahindura imiti uko bikwiye kugira ngo barebe ko nta bibazo bikomeye by'ububabare ufite.