ICU Basics

Devices

ECMO Emergencies Algorithm

Air, decannulation, pump failure, low flow

Reviewed by Alex G, BSN, RN, CEN, CCRN, CMC, NREMT-P · From the Reference tab of the app

Each step lists what to do, then the choices that lead on. In the app the algorithm is tapped through one decision at a time.

1 Which emergency?

Air in the circuit → step 2Decannulation or major bleed at the site → step 3Pump failure → step 4Low flow or chattering lines → step 5Sudden hypoxemia → step 6

2 Air in the circuit

  • Stop the pump, clamp the lines near the patient
  • Emergency ventilator settings; call the ECMO specialist
  • VA: support stops; prepare for CPR and pressors; de-air or change the circuit

End of this path.

3 Decannulation

  • Stop the pump and clamp; firm pressure on the site
  • Emergency vent settings; massive transfusion; call surgery
  • VA: CPR and pressors until support is restored

End of this path.

4 Pump failure

  • Clamp to stop backflow (VA)
  • Use the hand crank to restore flow at the last RPM
  • Emergency vent settings; replace the console or pump head

End of this path.

5 Low flow, chattering

  • Reduce RPM until chattering stops
  • Look for hypovolemia, bleeding, tamponade, pneumothorax, abdominal compartment, cannula position
  • Volume or blood as indicated; echo for position

End of this path.

6 Sudden hypoxemia

  • Check sweep gas connection and FdO₂; post-oxygenator gas
  • VV: recirculation, cannula position, high native cardiac output
  • VA femoral: right radial SpO₂ for differential hypoxemia

End of this path.

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