Issue |
J Extra Corpor Technol
Volume 56, Number 1, March 2024
|
|
---|---|---|
Page(s) | 20 - 29 | |
DOI | https://doi.org/10.1051/ject/2023047 | |
Published online | 15 March 2024 |
Review Article
Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout
1
Perfusionist & ECMO Specialist, Heart Vascular and Thoracic Institute, Cleveland Clinic, PO BOX: 112412, Abu Dhabi, United Arab Emirates
2
Perfusion Department, Cleveland Clinic, PO BOX: 112412, Abu Dhabi, United Arab Emirates
3
Clinical Perfusionist, Department of CTVS, All India Institute of Medical Science, Rishikesh
4
Clinical Perfusionist, Perfusion Department, Glenfield Hospital, Leicester, UK
5
Consultant of Cardiovascular Critical Care, Co-Chair of ECMO Task Force, Department of Health, United Arab Emirates
* Corresponding author: buttsab9@hotmail.com
Received:
19
July
2023
Accepted:
9
December
2023
Introduction: The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy. Methodology: A thorough search of relevant studies on ECMO circuits and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria. Discussion: Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects of this process. Conclusion: In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve the safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.
Key words: Extracorporeal membrane oxygenation (ECMO) / Circuit Change out / Monitoring / Key Indicators
© The Author(s), published by EDP Sciences, 2024
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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