| Popis: |
This chapter studies rhabdomyolysis due to extracorporeal membrane oxygenation (ECMO). Rhabdomyolysis and ischemic muscle injury may result in renal failure, loss of limb, and even death due to hyperkalemia and acidosis. The first step is to identify the cause of the muscle injury. The sheer size of ECMO arterial cannulae can cause decreased blood flow distal to cannula, especially in patients with small-caliber arteries. However, decreased blood flow may also be a manifestation of the technique used to cannulate the artery. Thus, knowledge of the type of cannulation access is required in order to ascertain if ischemia is likely due to the cannulation technique and to evaluate strategies to revise or replace the cannulation site. The chapter then considers the various techniques used to acquire femoral arterial cannulation for ECMO, which may vary in the risk of peripheral ischemia. Other potential sources of peripheral ischemic injury are ischemia due to reperfusion, ischemia–reperfusion injury, and arterial emboli. The chapter also addresses the treatment of rhabdomyolysis, the major goal of which is the prevention of acute kidney failure. |
