Clinical Complications Flashcards
ECMO Complication Types
Mechanical (Pump related)
Clinical (physiological; patient)
Complications
secondary conditions or events that develop in the course of primary tx, arising due to the primary tx or from independent causes
Crisis Resource Management
Management of events which make optimum use of all available resources, people, procedures, equipment- to promote safety and enhance efficacy during a crisis
What is the most common mechanical complication on ECMO?
Clots in the circuit (4038 reported; 29% reported, 76% survival)
What 3 mechanical complications have lower survival rates than the others?
Oxygenator failure (64%) Hemofilter malfunction (52%) Raceway rupture (67%)
When Confronted with a Complication….
- Breathe (relax and stay calm)
- Take control (remember: you are in charge)
- Think it through
- React
What clinical complications have lower survival rates than the rest?
Dialysis/hemofiltration (59%)
Infarction/ICH via ultrasound (50%)
Creatinine > 1.5 (57%)
Surgical site bleeding (52%)
Complications during ECMO
Bleeding 36% Neurological 19% Sepsisa 17% Renal 57% Pulmonary 21% Mechanical 47%
Limiting the duration of ECMO to ______ days due to increased risks of complications after approximately fourteen days of therapy.
Potential Risks
Insertion of tube into a blood vessel has an increased risk of infection Brain damage from head bleed surgical site bleeding pneumothorax hypertension cardiac dysrhythmias abnormal creatine and bilirubin values intraventricular hemorrhage air in circuit pump malfunction clots in the circuits pump malfunction heat exchanger malfunction
Potential Benefits
Being on ECMO will rest the lungs and heart so that there is an increased survival rate
Contraindications
Intracerebral hemorrhage severe brain damage multiple congenital anomalies irreversible brain damage weight
Treatment For Children
Hyaline membrane disease meconium aspiration Persistant fetal circulation congenital diaphragmatic hernia cardiac anomalies
Treatment For Adults
ARDS Non-necrotizing pneumonias Pulmonary contusion other reversible respiratory and cardiac failure not responsive to other measures post cardiac surgery