ECLS gone wrong… i.e. When ECMO attacks!!!

Greetings again from ECMOVember 2014!! Here is another lecture I gave at a recent ECMO training course. Today we have a picturesque look at the times when ECMO doesn’t go as planned…. My goal is that in 20 minutes I can show you that with some planning and prevention most of the ECMO-whoas can be avoided and bypassed. If you plan to bring ECMO to your hospital, or if you simply have had a run of great luck, I urge you to see what happens when that luck runs out….

Brief Summary

  • Of all the complications of ECMO, the most feared is ICH- however, this rare event occurs in only 1 in 25 pts, and of those about 1 in 5 survive [link]
  • To truly see where the errors lie you have to look at one of several points where things go wrong:
    • Cannulation
      • kinking (cannula or wire), misplacement, ventricular damage, vascular damage
    • Anticoagulation
      • clots in: cannula, return catheters, oxygenators, pumps
    • Expunging of air
      • Air in circuit from either poor cannulation technique or damage to equipment over time
    • Damage to lines/oxygenator
      • over aggressive clamping, over pressurization of oxygenator/system, use in non pressurized systems
    • Damage/failure of pump
      • low flow/kick back, pump failure
    • Problems with the patient
      • Capillary leak
      • Hemolysis
      • Bleeding
        • thrombocytopenia
        • DIC
        • ICH
      • Cardiac stun

To be honest… the only way to truly enjoy the lecture is to see it for yourself!! 

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