Optimal Management of the Critically Ill: Anaesthesia, Monitoring, Data Capture, and Point-of-Care Technological Practices in Ovine Models of Critical Care

Figure 1

An adult Merino ewe being prepared for venovenous extracorporeal membrane oxygenation (VV-ECMO). VV-ECMO is implemented in patients with severe respiratory failure refractory to conventional ventilatory support to provide gas exchange. Venous blood from the patient is accessed from large central veins and returned to the right atrium after it has passed through an oxygenator. The animal has been restrained in a sling cage (a); ventral neck hair has been clipped and aseptically prepared to allow intravenous access to be gained; note the brown colour of povidone iodine. A multilumen central venous catheter has been inserted into the left jugular vein of the animal under local anaesthetic and sutured into place (b) to allow for blood sampling and medications and fluid administration. The left jugular vein has been further cannulated with an 8G sheath for the insertion of a pulmonary artery catheter (c) for haemodynamic monitoring. An 11G sheath catheter has been inserted proximally into the left jugular vein under local anaesthetic and sutured into place to allow for intracardiac echocardiography (ICE) catheter to be inserted (d). The right jugular vein has been cannulated both proximally (e) and distally (f) with single lumen central lines to aid subsequent insertion of return and access ECMO cannulae, respectively. Incremental doses of midazolam are administered to maintain sheep comfort during the prolonged procedure.