Gas exchange in vv-ECMO is effected by four critical factors. There needs to be adequate effective ECMO blood flow compared to cardiac output and minimal recirculation. Oxygenation can then be set with the blender and carbon dioxide removal is determined by the sweep gas flow rate.
During a percutaneous tracheostomy procedure, the edge of the Shiley tracheostomy tube can catch on the tracheal rings deforming the shape and making it difficult to cannulate into the trachea. This can occur even if the bevels of the Shiley and trocar are aligned perfectly.
Fiberoptic oral intubation with flexible fiberoptic scope is useful technique for intubating a patient in respiratory distress which it is desirable to maintain spontaneously breathing during the intubation. Tutorial and procedure steps for performing fiberoptic awake oral intubation including equipment, preparation, and medications.
For patients that require prolonged mechanical ventilation, a tracheostomy can be placed either in the operating room as an open surgery, or more preferably at the bedside with a minimally invasive procedure in the intensive care unit by a percutaneous dilational technique under bronchoscopic guidance. This is a step-by-step tutorial for patient selection and procedure techniques.
Part of performing a bedside percutaneous tracheostomy is the procedural documentation. Given that this is a surgical procedure, the documentation should be more thorough than you may be accustomed to doing for an arterial line or central line. Here is a sample procedure note that can be adapted to your local practice.
ECMO circuits have a sideport to allow for easy connection for hemodialysis. However, they can be bumped or caught in clothing, which can crack or break the connector. This can cause significant blood loss, compromise the ECMO circuit, and place the patient at significant risk.
Accumulating clot in the ECMO oxygenator increases the pressure gradient across the membrane which then requires higher pumps to maintain the same blood flows through the circuit. A simple flashlight test can help you inspect the circuit and diagnose this problem.
ECMO pump chatter is caused by blood flow limitations from the venous side of the ECMO circuit. It occurs at higher RMPs and can limit the maximum blood flow in the circuit and cause excessive hemolysis. Monitoring and correcting this is important for maintaining a well functioning ECMO circuit.