What are the possible mechanical complications of pediatric ECMO?

Updated: Dec 21, 2017
  • Author: Edwin Rodriguez-Cruz, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Answer

Clots in the circuit are the most common mechanical complication (19%). Major clots can cause oxygenator failure, consumption coagulopathy, and pulmonary or systemic emboli. More recently, heparin-coated extracorporeal membrane oxygenation (ECMO) systems have been used to decrease the frequency of this complication.

Cannula placement can cause damage to the internal jugular vein, which causes massive mediastinal bleeding. Dissection of the carotid arterial intima can lead to lethal aortic dissection.

Air in the circuit can range from a few bubbles to a complete venous air lock. This air can originate in the dislodgement of the venous cannula, a small tear in the membrane, or high partial pressure of oxygen in the blood. A large bolus of air can be fatal.

Oxygenator failure is defined either as decreased oxygen or carbon dioxide transfer or as the presence of consumptive coagulopathy. A failing membrane should be replaced immediately.

Cracks in the connectors and tube rupture have become less serious problems since the introduction of Tygon raceway tubing.

Pump malfunction may be a manifestation of inadequate venous return to the pump; heat exchanger malfunction can cause severe hypothermia.

Failure of the entire circuit, including the oxygen source and oxygen blenders, may occur, as may failure of circuit-monitoring equipment. In cases of circuit failure, immediately clamp the venous line, open the bridge, and clamp the arterial line to remove the patient from the ECMO. Because the patient is ventilator dependent, immediately bag the patient with 100% oxygen (FiO2 =1) or shift the patient back to pre-ECMO ventilator settings.


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