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