ECMO-/ECLS

the airway, identifying edema and inflammatory changes to the tracheal
mucosa, such as hyperemia, mucosal ulceration and sloughing. It can also
serve as an adjunct to intubation in situations where a difficult airway may be
encountered such as patients with postburn facial and airway edema. In these
cases, intubation with a transnasally inserted endotracheal tube is preferable.
Please remember that the full extent of injury may not be evident until 12- 24
hours after the initial insult. Another definitive method of diagnosing inhalation
injury is Xenon 133 (^133 Xe) scanning in which the radioactive tracer,^133 Xe is
injected intravenously and exhaled from the lungs. Failure to clear the tracer in
90 seconds, or the segmental retention of it, is diagnostic of inhalation injury.
However, this technique requires transport to the nuclear medicine suite in a
patient who is already critically ill. Both of these techniques are more than
ninety percent accurate in determining the presence of inhalation injury.
Carbon monoxide (CO) is a component of smoke that results from
partial combustion of carbon-containing compounds such as cellulosics (wood,
paper, coal, charcoal), natural gases (methane, butane, propane) and
petroleum products. Carbon monoxide intoxication is a particularly serious
consequence of smoke inhalation and has been implicated in up to 80% of
fatalities. Any patient trapped in an enclosed space, or exhibiting neurologic
symptoms, should have carbon monoxide levels measured in addition to
concurrently receiving 100% oxygen with a tight-fitting mask for at least 4
hours. Symptoms of CO intoxication appear when the levels of
carboxyhemoglobin exceed 15%; levels of 40-50% may be reached after only