Clinical Complications

Question 1

ECMO Complication Types

Answer 1

Mechanical (Pump related)

Clinical (physiological; patient)

Question 2

Complications

Answer 2

secondary conditions or events that develop in the course of primary tx, arising due to the primary tx or from independent causes

Question 3

Crisis Resource Management

Answer 3

Management of events which make optimum use of all available resources, people, procedures, equipment- to promote safety and enhance efficacy during a crisis

Question 4

What is the most common mechanical complication on ECMO?

Answer 4

Clots in the circuit (4038 reported; 29% reported, 76% survival)

Question 5

What 3 mechanical complications have lower survival rates than the others?

Answer 5

Oxygenator failure (64%)
Hemofilter malfunction (52%)
Raceway rupture (67%)

Question 6

When Confronted with a Complication….

Answer 6

1. Breathe (relax and stay calm)
2. Take control (remember: you are in charge)
3. Think it through
4. React

Question 7

What clinical complications have lower survival rates than the rest?

Answer 7

Dialysis/hemofiltration (59%)
Infarction/ICH via ultrasound (50%)
Creatinine > 1.5 (57%)
Surgical site bleeding (52%)

Question 8

Complications during ECMO

Answer 8

Bleeding 36%
Neurological 19%
Sepsisa 17%
Renal 57%
Pulmonary 21%
Mechanical 47%

Question 9

Limiting the duration of ECMO to ______ days due to increased risks of complications after approximately fourteen days of therapy.

Question 10

Potential Risks

Answer 10

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

Question 11

Potential Benefits

Answer 11

Being on ECMO will rest the lungs and heart so that there is an increased survival rate

Question 12

Contraindications

Answer 12

Intracerebral hemorrhage
severe brain damage
multiple congenital anomalies
irreversible brain damage
weight

Question 13

Treatment For Children

Answer 13

Hyaline membrane disease
meconium aspiration
Persistant fetal circulation
congenital diaphragmatic hernia
cardiac anomalies

Question 14

Treatment For Adults

Answer 14

ARDS
Non-necrotizing pneumonias
Pulmonary contusion
other reversible respiratory and cardiac failure not responsive to other measures
post cardiac surgery