Patient Troubleshooting ECMO FINAL Flashcards
How would you diagnose Hypovolemia in general, while on ECMO ?
How will you manage it ?
- Low CVP
- Manage with fluid replacement
How would you diagnose Hypovolemia on VA-ECMO ?
- Low CVP
- Reduced Pulse Pressure not related to cardiac stun.
- Improved PaO2
How would you diagnose Hypovolemia on VV-ECMO ?
- Low CVP
- Poor Cardiac Output
- Increased SvO2 due to recirculation
- Decreased PaO2
How would you diagnose Hypervolemia in general while on ECMO ?
How will you manage it ?
- High CVP
- Diuretics / hemofiltration / fluid restriction
- Temporary management may include increasing pump flow.
How would you diagnose Hypervolemia on VA-ECMO ?
- High CVP
- Increased pulse pressure not associated with decreased pump flow
- Decreased PaO2
How would you diagnose Hypervolemia on VV-ECMO ?
- High CVP
- High Cardiac Output
- Decreased SvO2 due to recirculation
How would you diagnose a Pneumothorax or Tamponade while on ECMO ?
How will you manage it ?
- Pump is cutting out
- CVP is increasing due to a Pneumothorax
- Pump flow is decreasing
- Give volume, it gets better for a minute but it gets worse again.
- Diagnose with CXR and translumination
- Manage by relieving tension with a chest tube or open chest for cardiac surgery patients.
What can we expect to see from DIC (Disseminated Intravascular Coagulation) during ECMO ?
How will you manage it ?
- Increased Fibrin
- FDP/FSP
- Excessive platelet consumption
- As were decreasing ou heparin drip, ACTs are all over the place.
- Order a DIC panel: FSP & D-dimers
- Manage with FFP
- Identify and eliminate source of activation
Prolonged exposure to heparin and time on ECMO reduces clotting factor concentrations and ATIII concentrations causing consumptive coagulopathies.
How will you identify / manage this ?
- Identified by increased bleeding
- Visual inspection of ACT test tubes.
- Administer FFP
Arterial cannula placement is reflected in what ?
- Both, pre and post membrane pressures
Venous cannulation reflected in what ?
Combination of:
- CVP
- Bladder pressures & - Pump flow
How would you diagnose Poor Drainage while on ECMO ?
How will you manage it ?
- Normal or elevated CVP
- When you administer volume but drainage does not get any better.
What happens with a Hyperdynamic patient?
- High Hydrostatic pressure
- Low Colloid Oncotic Pressure
= EDEMA
How may you initially diagnose a patient that has an Intracranial Hemorrhage ?
How will you diagnose an ICH ?
How will you manage a patient with an ICH ?
Patient may present initially with SEIZURE activity.
- Repetitive motion of face, head, hands.
- Daily HUS (Head Ultrasound)
- Manage with barbiturates to reduce cerebral activity (metabolism)
How will you manage a patient with an ICH on ECMO ?
- Reduce ACT parameters
- Increase Platelet parameters
- ICH > Grade III = Termination of ECMO
