Category: Critical Care Nursing In ECMO, pseudoaneurysms present with a pulsatile, palpable bulge and if small, generally can be managed with injection of thrombin. If large or rapidly expanding, however, these defects will usually require surgical intervention.
Category: Critical Care Nursing Access of the femoral artery for VA-ECMO can lead to lower extremity ischemia, pseudoaneurysm formation, dissection and retroperitoneal bleeding. A distal perfusion cannula can be placed to mitigate limb ischemia.
Category: Critical Care Nursing During ECMO, several neurologic complications, including seizures, ischemic stroke, intracranial hemorrhage and brain death may occur. The cause of neurologic injury during ECMO is complex and likely multifactorial.
Category: Critical Care Nursing During ECMO, anticoagulation is administered during cannulation and is continued throughout the ECMO run to mitigate the risk of thrombosis in both the circuit and the patient. Unfractionated heparin remains the standard anticoagulant.
Category: Critical Care Nursing During ECMO, a massive inflammatory response occurs because of blood contact with the ECMO circuit, upregulating the coagulation system. Both activation and consumption of platelets occur, which induce changes in the coagulation cascade.
Category: Critical Care Nursing In patients with respiratory failure on VV-ECMO, right ventricular failure can occur due to pulmonary fibrosis and increased pulmonary vascular resistance from constant exposure to the high-pressure jet returning from the ECMO circuit.
Category: Critical Care Nursing In VV ECMO, the native heart must deliver oxygenated flow to the systemic circulation. VV requires adequate cardiac function. Venous blood is diverted from the patient and reinfused into the right atrium after gas exchange.
Category: Critical Care Nursing In veno-venous ECMO, deoxygenated blood is removed from the venous system and sent via an external pump to the membrane lung where oxygen is added and carbon dioxide removed. Oxygenated blood is then returned to the venous system.
Category: Critical Care Nursing In ECMO, for patients cannulated via the femoral artery, the use of pulse oximetry or arterial blood gas data from the right hand or use of cerebral near-infrared spectroscopy may help follow oxygen saturation levels.
Category: Critical Care Nursing In harlequin” or “north-south” syndrome, methods to improve upper body oxygenation include placing another venous cannula into the right atrium, then Y’ing it into the arterial ECMO return to direct oxygenated blood to the right atrium.
Category: Critical Care Nursing In ECMO, if desaturated blood from the left heart is primarily perfusing the upper body, this results in a cyanotic upper body with a well-perfused lower body, a condition for which the terms “harlequin” or “north-south” syndrome are used.
Category: Critical Care Nursing In ECMO patients with severe respiratory failure who are femoral artery cannulated, differential oxygen saturations of the upper and lower extremities can occur because of competing native cardiac output and returning circuit flow.
Category: Critical Care Nursing With ECMO, oxygenated blood is usually returned to the patient via the carotid or femoral artery. The femoral artery is preferred in adolescents and adults to prevent the need to repair or sacrifice the carotid artery at the time of decannulation.
Category: Critical Care Nursing With ECMO in venoarterial mode, deoxygenated blood is removed from the venous system and pumped to a membrane lung, which removes carbon dioxide and adds oxygen. Oxygenated blood is then returned to the patient via the arterial system.
Category: Critical Care Nursing Extracorporeal membrane oxygenation modes are named for the sites from which the blood is drained and returned. There are two major types, venoarterial (VA) and venovenous (VV). Hybrid modes incorporate VA and VV together.
