3 Steps to Separate from ECMO
1. Clamp Arterial (do this first to avoid negative pressure at the pumphead)
2. Clamp Venous
3. Support the Patient
Turn RPMs down to zero
Circuit Catastrophes
Air in the Circuit
Standard settings on the cardiohelp is to turn down RPMs if a bubble is detected. This is good on the aterial side, but is usually disabled by savvy players on the venous side.
If you see air on the venous side, the first move is to take off the cap (usually yellow) of the passive de-airing valve on the oxygenator
If you Airlock the Pump
- Clamp-Clamp-Support, Pump speed to zero
- Put Patient in Trendelenberg
- Raise the Tubing
- Ask for additional clamps to isolate the air
Search for a cause of the airleak
- Breach in the circuit
- Dislodged drainage cannula with exposed holes
- Central line
- Accidental injection of air
- Membrane lung rupture
- Cavitation
Fix the Cause
- Replace/repair/clamp broken component
- Cover hole with finger or bone wax
- Reposition cannula
- Clamp/cap central line
De-Air Circuit
Back prime the oxygenator
Reinitiate ECMO
- Increase RPM to Idle
- Remove the Venous clamp
- Remove the arterial clamp
- Increase the RPMs
Pump Failure
Causes include:
- Empty battery without access to wall power
- Damage to pump console
- Decoupling of centrifugal pump
Clamp-Clamp-Support-RPMs
Change to Hand-Crank Pump
Get a New Pump
Switch Back to New Pump
Circuit Rupture
Causes:
- Cracked Luer lock
- Broken pigtail
- Loose caps on ports
- Loose tubing to cannula connection
Pre-pump = air entrainment
Post-pump = hemorrhage
Accidental Decannulation
Immediate Clamp-Clamp
Arterial cannula will usually need to be immediately replaced through fresh cannulation
Venous cannula can usually be exchanged
needle through soft part of cannula -wire – sheath-superstiff – pull everything out over superstiff (leaving the sheath in, it is very hard to back the cannula alone back over a wire)
Catastrophic Clot
Clamp-Clamp-Support
Emergent Circuit Exchange