VA ECMO
This arterial monitoring site is generally preferred to assess upper-body oxygenation in peripheral femoral VA ECMO.
What is the right radial artery?
This is the primary organ system supported by VV ECMO.
What are the lungs?
A sudden increase in transmembrane pressure gradient across the oxygenator, especially with worsening gas transfer, raises concern for this.
What is oxygenator failure
ECMO stands for this.
What is extracorporeal membrane oxygenation?
A rising PaCO2 with a high post-oxygenator pCO2, despite adequate sweep, suggests this problem.
What is oxygenator dysfunction?
This small cannula, placed in the leg, is used to keep blood flowing below the femoral arterial cannula.
What is a distal perfusion catheter?
This circuit phenomenon occurs when oxygenated return blood is immediately drawn back into the drainage cannula instead of reaching the systemic circulation.
What is recirculation?
Dark urine, rising plasma-free hemoglobin, and increasing LDH in an ECMO patient raise concern for this complication.
What is hemolysis?
Anti-Xa, aPTT, and ACT are all used to monitor this therapy.
What is anticoagulation
When oxygenation declines and the post-oxygenator PaO2 is low, check this and its gas supply first.
What is oxygen blender and gas line
A VA ECMO patient develops increasing pulmonary edema, minimal aortic valve opening, and rising left-sided filling pressures. This complication should be suspected.
What is LV distension?
A VV ECMO patient has persistent hypercapnia and respiratory acidosis. This circuit parameter is commonly adjusted to increase CO₂ removal, provided the circuit and clinical context are appropriate.
What is sweep gas flow?
A patient with a femoral arterial cannula develops a cool, pale cannulated leg with diminished distal doppler signals. This complication is suspected.
What is limb ischemia?
If the console fails and the pump stops, this manual backup is used to keep the pump head turning.
What is the hand crank?
The pressure before the oxygenator rises while circuit flow remains the same. What should you investigate?
What is oxygenator clot
This phenomenon occurs when the native heart ejects poorly oxygenated blood to the upper body while femoral return perfuses the lower body.
What is Harlequin or north-south syndrome
During VV ECMO weaning, this is generally reduced in a controlled manner to assess whether the native lungs can maintain adequate gas exchange.
What is sweep gas flow?
The drainage line suddenly collapses and circuit flow falls. You should assess for these two broad causes.
What are inadequate venous drainage and a mechanical obstruction?
Chattering or shaking of the venous drainage line suggests this problem.
What is hypovolemia or inadequate venous return?
Flow suddenly falls to nearly zero, the drainage line is collapsed, and the patient becomes unstable. Name three immediate priorities.
What are assess the patient, call for help, and rapidly assess for drainage obstruction, or cannula displacement,
Raising VA ECMO flow increases this, which can impair LV ejection and lead to LV distension
What is afterload?
Despite a normal post-oxygenator PaO₂, a patient on VV ECMO continues to have a low SpO₂. What are five potential causes?
What are low effective ECMO flow relative to cardiac output, recirculation, anemia, increased oxygen consumption, or poor native lung gas exchange
A cannula becomes partially dislodged with active bleeding. Name the two immediate priorities.
What are controlling hemorrhage and preventing further cannula movement while urgently activating the cath lab?
Falling platelets plus new clotting on heparin raise concern for this, and bivalirudin may be used instead.
What is heparin-induced thrombocytopenia (HIT)?
A patient develops sudden low flow, hypotension, and rising central venous pressure. What serious cause should be considered?
What is cardiac tamponade or another cause of impaired venous return