Yini i-Extracorporeal Membrane Oxygenation (ECMO)? Inhloso, Inqubo & Nemiphumela

I-Extracorporeal membrane oxygenation, noma i-ECMO, ngumshini osekela impilo othatha isikhashana umsebenzi wenhliziyo namaphaphu akho uma egula kakhulu ukuthi angasebenza kahle. Cabanga ngayo njengokunika izitho zakho ezibalulekile ithuba lokuphumula nokuphola ngenkathi idivayisi ekhethekile igcina umoya-mpilo ugeleza emzimbeni wakho.

Le teknoloji yezokwelapha ethuthukisiwe isize izinkulungwane zabantu ukuthi basinde ezifweni ezingathi sína ezingase zibe yingozi. Ngenkathi i-ECMO igcinelwe izimo ezingathi sína kakhulu, ukuqonda ukuthi isebenza kanjani kungakusiza ukuthi uzizwe unolwazi olwengeziwe uma wena noma othandekayo wakho ngabe niyaludinga lolu hlobo lokwelashwa.

Yini i-ECMO?

I-ECMO ngumshini osebenza njengenhliziyo namaphaphu okwenziwa ngaphandle komzimba wakho. Isusa igazi emzimbeni wakho, ingeze umoya-mpilo kuwo, isuse i-carbon dioxide, bese ipompa igazi elisha elinikezwe umoya-mpilo libuyele emzimbeni wakho.

Lolu hlelo lusebenza ngamashubhu abizwa ngokuthi ama-cannula afakwa ngokuhlinzwa emithanjeni emikhulu yegazi. Igazi lakho lihamba ngala mashubhu liye emshinini we-ECMO, lapho lidlula khona emembraneni ekhethekile eyenza ukushintshana kwegesi amaphaphu akho avamise ukukwenza. Okwamanje, ipompo lenza umsebenzi ovamise ukwenziwa yinhliziyo yakho.

Kunezinhlobo ezimbili eziyinhloko zokusekelwa kwe-ECMO. I-Veno-venous (VV) ECMO iyasiza uma amaphaphu akho engasebenzi kodwa inhliziyo yakho isenamandla. I-Veno-arterial (VA) ECMO isekela inhliziyo namaphaphu akho uma zombili izitho zidinga usizo.

Kungani kwenziwa i-ECMO?

I-ECMO isetshenziswa uma inhliziyo yakho noma amaphaphu akho onakele kakhulu kangangokuthi angeke akwazi ukukugcina uphila wedwa, ngisho nangeminye imithi. Ngokuvamile kucatshangelwa uma ukwelashwa okujwayelekile njengama-ventilator nemithi kunganele ukugcina amazinga aphephile omoya-mpilo egazini lakho.

Iqembu lakho lezokwelapha lingase lincomende i-ECMO uma une-pneumonia enzima, izinkinga ze-COVID-19, noma i-acute respiratory distress syndrome (ARDS) engaphenduli ekusekelweni okukhulu kwe-ventilator. Lezi zimo zingenza amaphaphu akho avuvukale futhi alimale kangangokuthi angeke akwazi ukudlulisa umoya-mpilo emithanjeni yakho yegazi ngempumelelo.

Ngezinkinga ezihlobene nenhliziyo, i-ECMO ingase idingeke ngesikhathi sokuhlaselwa yinhliziyo okukhulu, ukwehluleka kwenhliziyo okukhulu, noma ngemva kokuhlinzwa kwenhliziyo okuthile lapho imisipha yenhliziyo yakho ibuthakathaka kakhulu ukumpompa igazi ngempumelelo. Ingase futhi isebenze njengokwelashwa kwebhuloho ngenkathi ulinde ukufakelwa kwenhliziyo.

Ngezinye izikhathi i-ECMO isetshenziswa ngesikhathi sokuboshwa kwenhliziyo lapho imizamo ejwayelekile yokuvuselela ingazange ibuyisele ukusebenza okujwayelekile kwenhliziyo. Kulezi zimo, umshini ungalondoloza ukujikeleza ngenkathi odokotela besebenza ukubhekana nenkinga eyabangela ukuboshwa.

Yini inqubo ye-ECMO?

Inqubo ye-ECMO iqala ngeqembu lakho lezokwelapha likubeka ngaphansi kwe-anesthesia ejwayelekile noma ukuthuliswa okujulile. Udokotela ohlinzayo noma udokotela oqeqeshwe ngokukhethekile uzobe esefaka ama-cannula emithanjeni emikhulu yegazi, ngokuvamile entanyeni yakho, emgodini, noma endaweni yesifuba.

Nge-VV ECMO, odokotela bavame ukubeka i-cannula enkulu eyodwa emthanjeni entanyeni yakho noma endaweni yomgodi. Le cannula eyodwa ingakwazi kokubili ukukhipha igazi emzimbeni wakho nokubuyisela igazi elinomsoco, nakuba ngezinye izikhathi kusetshenziswa ama-cannula amabili ahlukene.

I-VA ECMO idinga ukubeka ama-cannula emthanjeni nasemthanjeni. I-cannula ye-venous ikhipha igazi emzimbeni wakho, kuyilapho i-cannula ye-arterial ibuyisela igazi elinomsoco ngokuqondile ekujikelezeni kwakho kwe-arterial, idlula inhliziyo yakho ngokuphelele.

Uma ama-cannula esesendaweni, iqembu lakho lezokwelapha liwaxhuma kusekethe ye-ECMO. Uhlelo luhlanganisa ipompo, i-oxygenator (iphaphu lokwenziwa), kanye namadivayisi ahlukahlukene okuqapha. Umuthi wokunciphisa igazi unikezwa ukuvimbela ukwakheka kwamahlule kusekethe.

Kuyo yonke inqubo, izimpawu zakho ezibalulekile ziqashwa ngokuqhubekayo. Inqubo yonke yokusetha ngokuvamile ithatha ihora elilodwa kuya kwamabili, kuye ngobunzima besimo sakho nokuthi yiluphi uhlobo lokusekela lwe-ECMO oludingayo.

Ungalungiselela kanjani i-ECMO?

I-ECMO cishe ihlala iyindlela yokwelapha esiphuthumayo, ngakho-ke ngokuvamile akukho sikhathi sokulungiselela kwendabuko. Kodwa-ke, uma ucabangela i-ECMO, ithimba lakho lezokwelapha lizohlola ngokushesha ukuthi ungumuntu ofanelekayo yini kulokhu kwelashwa okukhulu.

Odokotela bakho bazobuyekeza umlando wakho wezokwelapha, imithi oyithathayo njengamanje, kanye nesimo sempilo yakho esiphelele. Bazokwenza nokuhlolwa kwegazi ukuze bahlole ukusebenza kwegazi lakho, ukusebenza kwezinso, nezinye izici ezibalulekile ezithinta ukuthi uzokwazi kangakanani ukubekezelela i-ECMO.

Uma uqaphela, ithimba lakho lezokwelapha lizochaza inqubo nezingozi zayo kuwe noma emndenini wakho. Bazoxoxa ngezindlela zokwelapha ezingezinye futhi bakusize uqonde ukuthi kungani i-ECMO inconywa esimweni sakho esithile.

Ithimba lakho lokunakekela lizoqinisekisa futhi ukuthi unokufinyelela okwanele kwe-IV futhi lingase libeke amadivayisi okuqapha engeziwe njemiqulu yezinzwa ukuze lilandelele umfutho wakho wegazi ngokuqhubekayo. Uma ungakabi se-ventilator, kungenzeka ukuthi kuzobekwa eyodwa ukusiza ukuvikela indlela yakho yomoya ngesikhathi senqubo.

Ungazifunda kanjani imiphumela yakho ye-ECMO?

I-ECMO ayikhiqizi imiphumela yokuhlolwa ngomqondo wendabuko, kodwa ithimba lakho lezokwelapha liqapha ngokuqhubekayo izinombolo eziningana ezibalulekile ukuze liqinisekise ukuthi uhlelo lusebenza kahle. Lezi zilinganiso zitshela odokotela ukuthi umshini usekela kahle kangakanani izidingo zomzimba wakho.

Amanani okuhamba kwegazi alinganiswa ngamalitha ngomzuzu futhi abonisa ukuthi kungakanani igazi elihamba ngesekethe ye-ECMO. Amanani aphezulu okuhamba ngokuvamile asho ukusekelwa okwengeziwe, kodwa izinombolo eziqondile zincike osayizini yomzimba wakho nesimo sezokwelapha.

Amazinga e-oksijini egazini lakho alandelwa ngokulinganisa igesi yegazi njalo. Ithimba lakho lifuna amazinga okugcwala kwe-oksijini angaphezu kuka-88-90% kanye namazinga e-carbon dioxide ebangeni elijwayelekile, okukhombisa ukuthi iphaphu lokwenziwa lisebenza ngempumelelo.

Ithimba lakho lezokwelapha libuye liqaphe isivinini sephampu, esilinganiswa ngamajikajika ngomzuzu (RPMs). Lawa majubane alungiswa ngokusekelwe ekutheni inhliziyo namaphaphu akho adinga ukusekelwa okungakanani njengoba isimo sakho sishintsha.

Izivivinyo zaselabhorathri zenziwa njalo ukuze kuhlolwe izimpawu zokuphuma kwegazi, ukujiya kwegazi, ukusebenza kwezinso, nezinye izinkinga. Odokotela bakho basebenzisa zonke lezi zilinganiso ndawonye ukuze balungise izilungiselelo zakho ze-ECMO futhi bahlele ukwelashwa kwakho konke.

Ungayithuthukisa kanjani ukusekelwa kwakho kwe-ECMO?

Ngesikhathi use-ECMO, ithimba lakho lezokwelapha lisebenza ngokuqhubekayo ukuthuthukisa ukusekelwa okutholayo. Lokhu kuhlanganisa ukulinganisela ngokucophelela izilungiselelo zomshini nezidingo zomzimba wakho ezishintshayo njengoba isimo sakho esingaphansi sithuthuka noma siba sibi kakhulu.

Odokotela bakho bazolungisa amazinga okugeleza kwegazi namazinga e-oksijini ngokusekelwe emiphumeleni yakho yaselebhu kanye nesimo somtholampilo. Bangase bandise ukusekelwa uma izitho zakho zidinga usizo olwengeziwe, noma banciphise kancane kancane njengoba inhliziyo namaphaphu akho eqala ukululama.

Ukuvimbela izinkinga kuyingxenye ebalulekile yokuphathwa kwe-ECMO. Ithimba lakho likuqapha eduze ukuze lithole ukuphuma kwegazi, ukujiya kwegazi, kanye nokutheleleka. Bazolungisa imithi yakho yokunciphisa igazi futhi bangase benze izinqubo zokubhekana nanoma yiziphi izinkinga eziphakamayo.

Ukwelashwa ngokomzimba kuvame ukuqala ngenkathi use-ECMO, ngisho noma udakiwe. Lokhu kusiza ukuvimbela ubuthakathaka bemisipha kanye namahlule egazi. Umelaphi wakho wokuphefumula uzosebenza namaphaphu akho ukuze akhuthaze ukuphulukiswa futhi avimbele ukulimala okuqhubekayo.

Umgomo uhlala ukukuyeka ukusekelwa kwe-ECMO ngokushesha nangokuphepha ngangokunokwenzeka. Ithimba lakho lezokwelapha lizokwehlisa kancane kancane usizo lomshini njengoba inhliziyo namaphaphu akho okululama umsebenzi wawo.

Ziyini izici eziyingozi zokudinga i-ECMO?

Izimo eziningi zezokwelapha zingakhuphula amathuba akho okudinga ukusekelwa yi-ECMO. Ukuqonda lezi zinto eziyingozi kungakusiza ukuthi ubone ukuthi umuntu angase abe sengozini enkulu yezinkinga ezinzima zenhliziyo noma zamaphaphu.

Izimo ezinzima zokuphefumula ezingase zithuthuke ziye ku-ECMO zihlanganisa:

• Umkhuhlane onzima ongayiphenduli imithi elwa namagciwane nokusekelwa yi-ventilator
• I-COVID-19 enezinkinga ezinzima zamaphaphu
• I-Acute respiratory distress syndrome (ARDS) evela ezintweni ezihlukahlukene
• Ukuhlaselwa okukhulu kwesifuba esingaphenduli ekwelashweni okuphezulu kwezokwelapha
• Ukuminza noma ukulimala okubangelwa ukuhogela intuthu

Lezi zimo zingabangela umonakalo omkhulu kangangokuthi ngisho nama-ventilator anengcindezi ephezulu angeke akwazi ukugcina amazinga omoya-mpilo anele egazini lakho.

Izimo ezihlobene nenhliziyo ezingase zidinge ukusekelwa yi-ECMO zihlanganisa:

• Ukuhlaselwa yinhliziyo okukhulu okonakalisa izingxenye ezinkulu zomzimba wenhliziyo
• Ukwehluleka kwenhliziyo okukhulu okungaphenduli emithini
• Izinkinga ngemuva kokuhlinzwa kwenhliziyo
• I-Cardiogenic shock lapho inhliziyo ingakwazi ukumpompa igazi elanele
• Izinkinga ezinzima zesigqi senhliziyo ezibangela ukuboshwa kwenhliziyo

Izinto ezithile zesiguli nazo zingakhuphula ingozi ye-ECMO, okuhlanganisa ukuguga, izimo eziningi zezokwelapha ezingapheli, kanye nesifo senhliziyo noma samaphaphu esandulele. Kodwa-ke, izinqumo ze-ECMO zenziwa ngaso sonke isikhathi ngokuya ngesimo sakho ngasinye kunokuba lezi zinto eziyingozi ezivamile zodwa.

Ingabe i-ECMO ingcono ekusekeleni inhliziyo noma ekusekeleni amaphaphu?

I-ECMO ingasekelwa ngempumelelo kokubili umsebenzi wenhliziyo namaphaphu, kodwa uhlobo lokusekelwa luya ngokuthi yiziphi izitho ezidinga usizo. I-VV ECMO yenzelwe ngokuqondile ukusekela amaphaphu, kuyilapho i-VA ECMO ingasekelwa kokubili umsebenzi wenhliziyo namaphaphu ngasikhathi sinye.

Ngezinkinga zamaphaphu kuphela, i-VV ECMO ivame ukukhethwa ngoba ivumela inhliziyo yakho ukuthi iqhubeke isebenza ngokujwayelekile ngenkathi inika amaphaphu akho isikhathi sokuphola. Le ndlela igcina umsebenzi wemvelo wenhliziyo yakho futhi ingaholela emiphumeleni engcono yesikhathi eside.

Uma inhliziyo yakho ihluleka, i-VA ECMO inikeza ukwesekwa okuningi ngokuthatha imisebenzi yokuphumpa kanye ne-oxygenation. Lokhu kunika inhliziyo yakho namaphaphu ithuba lokululama kunoma yisiphi isimo esibangele le nkinga.

Ukukhetha phakathi kwezinhlobo ze-ECMO kuncike esimweni sakho esithile sezokwelapha, ukuthi inhliziyo yakho isebenza kahle kangakanani, kanye nesimo sakho sempilo esiphelele. Ithimba lakho lezokwelapha lizokhetha indlela enikela ngethuba elingcono kakhulu lokululama.

Ziyini izinkinga ezingaba khona ze-ECMO?

Ngenkathi i-ECMO ingasindisa impilo, ithwala izingozi ezinkulu ezizogadwa eduze yithimba lakho lezokwelapha. Ukuqonda lezi zinkinga ezingaba khona kungakusiza wena nomndeni wakho ukuthi nazi okumele nikulindele ngesikhathi sokwelashwa.

Ukuphuma kwegazi kungenye yezinkinga ezivame kakhulu ngoba i-ECMO idinga imithi yokunciphisa igazi ukuvimbela amahlule emjikelezweni. Lokhu kungaholela ekuphumeni kwegazi ngasezindaweni ze-cannula, ebuchosheni bakho, noma kwezinye izindawo zomzimba wakho.

Amahule egazi angakheka naphezu kwemithi yokunciphisa igazi, okungenzeka ukuthi ivimbele ukuhamba kwegazi ezingxenyeni ezibalulekile zomzimba. Ithimba lakho lezokwelapha lenza izivivinyo ezivamile ukuze lilawule ingozi yokuphuma kwegazi ngokumelene nengozi yokuhluleka.

Ukutheleleka kungenye into ekhathazayo, ikakhulukazi ngasezindaweni zokufaka i-cannula noma emgudwini wakho wegazi. Uma uba nesikhathi eside ku-ECMO, iba phezulu le ngozi, yingakho odokotela besebenza ukukukhipha ekusekelweni ngokushesha ngangokunokwenzeka.

Izinkinga zezinso zingase zivele ngenxa yokucindezeleka kokugula okukhulu kanye nenqubo ye-ECMO ngokwayo. Ezinye iziguli zingase zidinge i-dialysis yesikhashana ukusekela umsebenzi wazo wezinso ngesikhathi sokululama.

Izinkinga ezingavamile kodwa ezinzima zihlanganisa:

• Ukushaywa unhlangothi olubangelwa amahlule egazi noma ukuphuma kwegazi ebuchosheni
• Umonakalo emithanjeni yegazi ovela kuma-cannula
• Izinkinga nge-ECMO circuit ezidinga ukulungiswa ngokushesha
• Izinkinga ezivela ekuthulisweni isikhathi eside nokunganyakazi

Ithimba lakho lezokwelapha likuqapha ngokuqhubekayo ukuze libone lezi zinkinga futhi linesimiso sokuziphatha ukuze zisingathwe ngokushesha uma zenzeka.

Kufanele ngibone nini udokotela mayelana ne-ECMO?

I-ECMO ngokuvamile iqaliswa ezindaweni zasemtholampilo ngesikhathi sezimo eziphuthumayo zezokwelapha, ngakho-ke isinqumo ngokuvamile akuyona into oyenzayo ngokuzimela. Kodwa-ke, zikhona izimo lapho ungase ufune ukuxoxa nge-ECMO nabahlinzeki bakho bezempilo.

Uma unesifo senhliziyo noma samaphaphu esibi, ungase ufune ukubuza udokotela wakho mayelana ne-ECMO njengenketho yokwelashwa okungenzeka ngesikhathi sokugula okukhulu. Le ngxoxo ingakusiza ukuthi uqonde ukuthi ungaba ngumuntu ofanelekayo yini kule therapy.

Imindeni yeziguli ezise-ECMO njengamanje kufanele igcine ukuxhumana njalo nethimba lezokwelapha mayelana nemigomo yokunakekelwa, izimpawu zokuqhubeka, kanye nokulindela okungokoqobo kokululama. Lezi zingxoxo zisiza ekuqinisekiseni ukuthi wonke umuntu uqonda uhlelo lokwelapha.

Uma ucabangela i-ECMO njengebhuloho lokuya ekufakweni kwenhliziyo noma yamaphaphu, xoxa ngale nketho nethimba lakho lokufakelwa ngaphambi kokunakekelwa kwakho. Bangakusiza ukuthi uqonde ukuthi i-ECMO ingangena kanjani esu lakho lokwelapha lonke.

Ezigulini ezinemiqondiso ethuthukisiwe, kubalulekile ukuxoxa ngezintandokazi zakho mayelana nokwelashwa okukhulu njenge-ECMO nabahlinzeki bakho bezempilo kanye namalungu omndeni ngaphambi kokuthi kube nosizi.

Imibuzo evame ukubuzwa mayelana ne-ECMO

Q.1 Ingabe i-ECMO ilungile ekuhlulekeni kwenhliziyo?

I-ECMO akulona uhlobo lokuhlola - kuyindlela yokwelapha engahlinzeka ngosizo olusindisa impilo ekuhlulekeni okukhulu kwenhliziyo lapho ezinye izindlela zokwelapha zingasebenzi. I-VA ECMO ingathatha umsebenzi wokumpompa wenhliziyo yakho, inikeze imisipha yenhliziyo yakho isikhathi sokululama noma isebenze njengebhuloho lokufakelwa kwenhliziyo. Kodwa-ke, isetshenziswa kuphela ezimweni ezinzima kakhulu lapho inhliziyo yakho ingakwazi ukugcina ukujikeleza ngaphandle kokwelashwa okukhulu kwezokwelapha.

Q.2 Ingabe i-ECMO ibangela izinkinga?

Yebo, i-ECMO ingabangela izinkinga eziningana ezihlanganisa ukopha, amahlule egazi, ukutheleleka, nezinkinga zezinso. Ingozi yezinkinga iyanda ngesikhathi eside sokwelashwa, yingakho ithimba lakho lezokwelapha lisebenza ukukususa ekusekelweni yi-ECMO ngokushesha ngangokunokwenzeka. Naphezu kwalezi zingozi, i-ECMO ingasindisa impilo ezigulini ezinokuhluleka okukhulu kwenhliziyo noma yamaphaphu ezingeke zisinde ngaphandle kwalolu sizo.

Q.3 Umuntu angahlala isikhathi esingakanani ku-ECMO?

Ubude bosizo lwe-ECMO buhluka kakhulu kuye ngesimo sakho esiyisisekelo nokuthi izitho zakho zithola ngokushesha kangakanani. Ezinye iziguli zidinga ukusekelwa izinsuku ezimbalwa nje, kanti ezinye zingase zidinge amasonto amaningana noma izinyanga. Ngokuvamile, izikhathi ezimfushane zihlotshaniswa nemiphumela engcono, ngakho ithimba lakho lezokwelapha lizosebenza ukunciphisa isikhathi osichitha ku-ECMO ngenkathi liqinisekisa ukuthi izitho zakho zinesikhathi esanele sokuphola.

Q.4 Ungasinda ku-ECMO?

Yebo, iziguli eziningi zisinda ekwelashweni kwe-ECMO futhi ziqhubeke nokuphila izinga elihle. Amazinga okusinda ancika ezintweni ezinjengobudala bakho, izimo zempilo eziyisisekelo, nesizathu sokuthi udinga usizo lwe-ECMO. Iziguli ezinanezinkinga zamaphaphu ngokuvamile zinamazinga okusinda aphezulu kunezazo ezinanezinkinga zenhliziyo, futhi iziguli ezincane ngokuvamile zenza kangcono kunezindala. Ithimba lakho lezokwelapha linganikeza imininingwane ecacile mayelana nokubikezela kwakho komuntu ngamunye.

Q.5 Ingabe i-ECMO ibuhlungu?

Iningi labantu abase-ECMO lithola imithi yokudambisa nokudambisa ubuhlungu ukuze bazizwe bekhululekile ngesikhathi sokwelashwa. Inqubo yokufaka i-cannula yenziwa ngaphansi kwe-anesthesia, ngakho ngeke uzizwe ubuhlungu ngesikhathi sokufakwa. Ngesikhathi use-ECMO, ithimba lakho lezokwelapha lilawula ngokucophelela amazinga akho okukhululeka futhi lilungise imithi njengoba kudingeka ukuqinisekisa ukuthi awuzizwa unganethezekile kakhulu.