Hello everyone, today we are talking about a child colonial life support. And Dr. Zhang Wang, associate professor of cardiovascular surgery in National Taiwan University Hospital. This, is today's outline, first, we'll have introduction to discuss about physiology of circulation and the history of ECMO. The second part is how does ECMO work, we will talk about essential component of ECMO, the VA-ECMO mode, the VV-ECMO mode and then we are talking about application of ECMO. Application ECMO in cardiac support in lung support, and the ECMO assisted CPR, which means ECPR. First introduction, the physiology of circulation, that blood comes from the Vena side, like a rhino vein, hepactic vein or the upper body and all a dark blood will trains to vena cava. Goes in to the right atrium and the right ventricle and the right ventricle will pump the dark blood in to the pulmonary artery and goes in to the lung. The pulmonary circulation, in lung in pulmonary circulation flooded blood will receive the oxygenation and become the red blood. The red blood will go back to left atrium, so the pulmonary vein and goes to the left ventricle and the pumping to the body through the aotar to the upper body to the visceral organ like the liver, stomach, intestine, renal kidney and lower body. So this is normal physiology of a situation. Now what is ECMO? The ECMO is the abbreviation of Extracorporeal Membrane Oxygenation E C M O, sometimes we will have circular paper literature and someone will call ECMO as PCPs Percutaneous Cardiopulmonary Support. But a nowaday, we would like to use the term ECLS Extracorporeal Life Support. So ECLS or ECMO, actually it's in terms, Extracorporeal Life Support, ECLS or Extracorporeal Membrane Oxygenation, ECMO in the ELSO guidelines. It's defined as the use of mechanical device to temporary it means days to months to support heart or lung function. Sometimes it's partially support and sometimes it's totally support during cardiopulmonary failure, and by using the ECLS or ECMO this will lead to organ recovery or replacement. What is the cardiopulmonary bypass? During the open heart surgery we will have to stop and empty the heart and lungs so that we can operate inside the heart. So we have to let a little blood up a bypass the heart and lung. So the machine sometimes we called Heart-Lung machine. Now cardiopulmonary bypass, we will have the drainage cannula in superior vena cava that inferior vena cava drains all the dark blood to the oxygenation and using a pump to pump the red blood in to our aorta to support the system. So during the operation during the open heart surgery, we cross cramp the outer drainage, all the bladder to the Harlan machine, so we can stop the heart and the empty the heart and we can do many things on the heart. So, the heart-lung machine have two main purpose. One is to pump in the blood as heart, the second is to provide gas exchange as lung. And what's different between Heart-lung machine and ECMO? Actually, the ECMO is simplified from cardiopulmonary bypass machine. We keep the essential part of the heart-lung machine. We keep the pump to work as a heart and to keep like actually nation, the artificial lung to work as lung. So we simplified the huge, complicate heart lung machine to a very simple machine, we so called this machine ECMO.. So what is ECMO? It's a simplified cardiopulmonary bypass, we can use ECMO for prolong use. It means up to weeks when compared with cardiopulmonary bypass machine, the hollow machine in open heart. The hollow machine just used for hours in the operation room. And the ECMO only gives partial support, which means up to four liter per minute when compared with cardiopulmonary bypass machine in operation room, we usually turn up the halon machine up to five liters per minute. So, history of ECMO in 1953 Dr. Gibbon, he did the first extracorporeal defect repair. It's a kind of congenital heart using extracorporeal support at that time, the machine using a roller pump, our sort of first to support the first Harlan machine model. In 1954, Dr. Lillehei, he did the first cardiac surgery using bubble oxygenator. In 1957, Dr. Kolobow Drinker and Dr. Bartlett design and use the first silicone membrane oxygenator. It's a prototype of ECMO, that we nowadays use. In 1972, Dr. Hill did the first adult ECMO surgery in post traumatic lung injury patient. Meanwhile, in 1972, Dr. Ballet also did the first pediatric ECMO in postcardiotomy after Mustard procedure. Mustard procedure is also an congenital heart surgery, a kind of complex congenital heart surgery. In 1975, Dr. Barllett use the ECMO to treat the first neonatal respiratory failure. The patient was a mechanical aspiration patient and it was the milestone of ECMO because, using the ECMO the doctor Barllett lead let survival from 10% rise to 75%. So Dr. Barllett nowaday was called to be the father of ECMO. In 1989, Dr. Barllett establish the ELSO organization and promote the ECMO to worldwide.