Original Article

Trouble Shooting the Extracorporeal Membrane Oxygenator Circuit and Patient

Departments of Cardiothoracic Surgery and Pediatric Cardiology, David M. Clark Cardiovascular Center, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas

^* Address correspondence to: Sherry C. Faulkner, CCP ECMO Unit Arkansas Children's Hospital BOO Marshall Street Little Rock, Arkansas 72202

Abstract

Patients requiring extracorporeal membrane oxygenation (ECMO) often become totally dependent on the mechanical life support. The Extracorporeal Life Support Organization (ELSO) reports 2486 incidents of mechanical complications in 5905 ECMO supports. To help decrease the number of mechanical complications, an active quality assurance program was initiated at our institution. This resulted in identification of only 14 incidents of mechanical complications in 100 patients (neonate, pediatric, adult, and cardiac). Techniques for dealing with problems such as loss of roller pump occlusion, changing out of the membrane lung or heat exchanger without interrupting ECMO support, venous air lock, tamponade, emergency transfusion, and other situations were generated into written policies and procedures.

We routinely review and practice problem solving techniques with specific emphasis on monitoring patient hemodyanmics and appearance.

We conclude that written policies and procedures, “water drills,” and continuing education can be beneficial in early recognition, intervention, and/or prevention of ECMO mechanical complications.