Skip to main content
SpringerLink
Log in

Crises During ECLS

  • Chapter
Extracorporeal Life Support for Adults

Part of the book series: Respiratory Medicine ((RM,volume 16))

  • 2283 Accesses

Abstract

Expeditious recognition and effective intervention during crises is essential to the successful management of patients receiving extracorporeal life support (ECLS). Crises during ECLS can be partitioned into those originating in the circuit and those originating in the patient. Circuit crises, such as the presence of circuit air, thrombosis, oxygenator failure, pump failure, tubing rupture, heater malfunction, and inadvertent decannulation, and patient crises such as bleeding, hemolysis, refractory hypoxemia, and shock, may quickly become life-threatening emergencies. Providers must be trained to promptly identify and respond to both common and uncommon complications of ECLS in order to optimize patient safety and improve clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kopp R, Mottaghy K, Kirschfink M. Mechanism of complement activation during extracorporeal blood-biomaterial interaction: effects of heparin coated and uncoated surfaces. ASAIO J. 2002;48(6):598–605.

    Article  CAS  PubMed  Google Scholar 

  2. Deptula J, Glogowski K, Merrigan K, Hanson K, Felix D, Hammel J, et al. Evaluation of biocompatible cardiopulmonary bypass circuit use during pediatric open heart surgery. J Extra Corpor Technol. 2006;38(1):22–6.

    PubMed  Google Scholar 

  3. Combes A, Bacchetta M, Brodie D, Muller T, Pellegrino V. Extracorporeal membrane oxygenation for respiratory failure in adults. Curr Opin Crit Care. 2012;18(1):99–104.

    Article  PubMed  Google Scholar 

  4. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365(20):1905–14.

    Article  CAS  PubMed  Google Scholar 

  5. Pollak U, Yacobobich J, Tamary H, Dagan O, Manor-Shulman O. Heparin-induced thrombocytopenia and extracorporeal membrane oxygenation: a case report and review of the literature. J Extra Corpor Technol. 2011;43(1):5–12.

    PubMed  Google Scholar 

  6. Koster A, Weng Y, Bottcher W, Gromann T, Kuppe H, Hetzer R. Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT. Ann Thorac Surg. 2007;83(5):1865–7.

    Article  PubMed  Google Scholar 

  7. Lee GM, Arepally GM. Diagnosis and management of heparin-induced thrombocytopenia. Hematol Oncol Clin North Am. 2013;27(3):541–63.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Warkentin TE, Greinacher A, Gruel Y, Aster RH, Chong BH. Laboratory testing for heparin-induced thrombocytopenia: a conceptual framework and implications for diagnosis. J Thromb Haemost. 2011;9(12):2498–500.

    Article  CAS  PubMed  Google Scholar 

  9. Extracorporeal Life Support Organization. ECLS registry report, international summary. January 2013.

    Google Scholar 

  10. Sell LL, Cullen ML, Whittlesey GC, Yedlin ST, Philippart AI, Bedard MP, et al. Hemorrhagic complications during extracorporeal membrane oxygenation: prevention and treatment. J Pediatr Surg. 1986;21(12):1087–91.

    Article  CAS  PubMed  Google Scholar 

  11. Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F, et al. Low-frequency positive-pressure ventilation with extracorporeal CO removal in severe acute respiratory failure. JAMA. 1986;256(7):881–6.

    Article  CAS  PubMed  Google Scholar 

  12. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302(17):1888–95.

    Article  CAS  PubMed  Google Scholar 

  13. Davies A, Jones D, Gattas D. Extracorporeal membrane oxygenation for ARDS due to 2009 influenza A(H1N1)—reply. JAMA. 2010;303(10):941–2.

    Article  Google Scholar 

  14. Patroniti N, Zangrillo A, Pappalardo F, Peris A, Cianchi G, Braschi A, et al. The Italian ECMO network experience during the 2009 influenza A(H1N1) pandemic: preparation for severe respiratory emergency outbreaks. Intensive Care Med. 2011;37(9):1447–57.

    Article  PubMed  Google Scholar 

  15. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351–63.

    Article  PubMed  Google Scholar 

  16. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288(12):1499–507.

    Article  PubMed  Google Scholar 

  17. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340(6):409–17.

    Article  CAS  PubMed  Google Scholar 

  18. Hebert PC, Fergusson DA. Red blood cell transfusions in critically ill patients. JAMA. 2002;288(12):1525–6.

    Article  PubMed  Google Scholar 

  19. Butch SH, Knafl P, Oberman HA, Bartlett RH. Blood utilization in adult patients undergoing extracorporeal membrane oxygenated therapy. Transfusion. 1996;36(1):61–3.

    Article  CAS  PubMed  Google Scholar 

  20. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358(12):1229–39.

    Article  CAS  PubMed  Google Scholar 

  21. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med. 2004;32(1):39–52.

    Article  PubMed  Google Scholar 

  22. Marik PE, Corwin HL. Acute lung injury following blood transfusion: expanding the definition. Crit Care Med. 2008;36(11):3080–4.

    Article  PubMed  Google Scholar 

  23. Shorr AF, Duh MS, Kelly KM, Kollef MH. Red blood cell transfusion and ventilator-associated pneumonia: a potential link? Crit Care Med. 2004;32(3):666–74.

    Article  PubMed  Google Scholar 

  24. Ferraris VA, Davenport DL, Saha SP, Bernard A, Austin PC, Zwischenberger JB. Intraoperative transfusion of small amounts of blood heralds worse postoperative outcome in patients having noncardiac thoracic operations. Ann Thorac Surg. 2011;91(6):1674–80. discussion 1680.

    Article  PubMed  Google Scholar 

  25. Ferraris VA, Davenport DL, Saha SP, Austin PC, Zwischenberger JB. Surgical outcomes and transfusion of minimal amounts of blood in the operating room. Arch Surg. 2012;147(1):49–55.

    Article  PubMed  Google Scholar 

  26. Simon T, Snyder EL, Solheim BG. Rossi’s principles of transfusion medicine. 4th ed. West Sussex, UK: Wiley-Blackwell; 2009.

    Book  Google Scholar 

  27. Roback JD, Neuman RB, Quyyumi A, Suliff R. Insufficient nitric oxide bioavailability: a hypothesis to explain adverse effects of red blood cell transfusion. Transfusion. 2011;51(4):859–66.

    Article  CAS  PubMed  Google Scholar 

  28. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012;157(1):49–58.

    Article  PubMed  Google Scholar 

  29. Plotz FB, van Oeveren W, Bartlett RH, Wildevuur CR. Blood activation during neonatal extracorporeal life support. J Thorac Cardiovasc Surg. 1993;105(5):823–32.

    CAS  PubMed  Google Scholar 

  30. Anderson III HL, Cilley RE, Zwischenberger JB, Bartlett RH. Thrombocytopenia in neonates after extracorporeal membrane oxygenation. ASAIO Trans. 1986;32(1):534–7.

    Article  PubMed  Google Scholar 

  31. Robinson TM, Kickler TS, Walker LK, Ness P, Bell W. Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med. 1993;21(7):1029–34.

    Article  CAS  PubMed  Google Scholar 

  32. Stallion A, Cofer BR, Rafferty JA, Ziegler MM, Ryckman FC. The significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion. 1994;9(4):265–9.

    Article  CAS  PubMed  Google Scholar 

  33. Lamb KM, Cowan SW, Evans N, Pitcher H, Moritz T, Lazar M, et al. Successful management of bleeding complications in patients supported with extracorporeal membrane oxygenation with primary respiratory failure. Perfusion. 2013;28(2):125–31.

    Article  CAS  PubMed  Google Scholar 

  34. Downard CD, Betit P, Chang RW, Garza JJ, Arnold JH, Wilson JM. Impact of AMICAR on hemorrhagic complications of ECMO: a ten-year review. J Pediatr Surg. 2003;38(8):1212–6.

    Article  PubMed  Google Scholar 

  35. Wilson JM, Bower LK, Fackler JC, Beals DA, Bergus BO, Kevy SV. Aminocaproic acid decreases the incidence of intracranial hemorrhage and other hemorrhagic complications of ECMO. J Pediatr Surg. 1993;28(4):536–40. discussion 540–1.

    Article  CAS  PubMed  Google Scholar 

  36. van der Staak FH, de Haan AF, Geven WB, Festen C. Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg. 1997;32(4):594–9.

    Article  PubMed  Google Scholar 

  37. Velik-Salchner C, Sergi C, Fries D, Moser P, Streif W, Kolbitsch C. Use of recombinant factor VIIa (novoseven) in combination with other coagulation products led to a thrombotic occlusion of the truncus brachiocephalicus in a neonate supported by extracorporal membrane oxygenation. Anesth Analg. 2005;101(3):924.

    Article  PubMed  Google Scholar 

  38. Wittenstein B, Ng C, Ravin H, Goldman A. Recombinant factor VII for severe bleeding during extracorporeal membrane oxygenation following open heart surgery. Pediatr Crit Care Med. 2005;6(4):473–6.

    Article  PubMed  Google Scholar 

  39. Dominguez TE, Mitchell M, Friess SH, Huh JW, Manno CS, Ravishankar C. Use of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2005;6(3):348–51.

    Article  CAS  PubMed  Google Scholar 

  40. Repesse X, Au SM, Brechot N, Trouillet JL, Leprince P, Chastre J. Recombinant factor VIIa for uncontrollable bleeding in patients with extracorporeal membrane oxygenation: report on 15 cases and literature review. Crit Care. 2013;17(2):R55.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Bui JD, Despotis GD, Trulock EP, Patterson GA, Goodnough LT. Fatal thrombosis after administration of activated prothrombin complex concentrates in a patient supported by extracorporeal membrane oxygenation who had received activated recombinant factor VII. J Thorac Cardiovasc Surg. 2002;124(4):852–4.

    Article  PubMed  Google Scholar 

  42. Syburra T, Lachat M, Genoni M, Wilhelm MJ. Fatal outcome of recombinant factor VIIa in heart transplantation with extracorporeal membrane oxygenation. Ann Thorac Surg. 2010;89(5):1643–5.

    Article  PubMed  Google Scholar 

  43. Morgan IS, Codispoti M, Sanger K, Mankad PS. Superiority of centrifugal pump over roller pump in paediatric cardiac surgery: prospective randomised trial. Eur J Cardiothorac Surg. 1998;13(5):526–32.

    Article  CAS  PubMed  Google Scholar 

  44. Klein M, Dauben HP, Schulte HD, Gams E. Centrifugal pumping during routine open heart surgery improves clinical outcome. Artif Organs. 1998;22(4):326–36.

    Article  CAS  PubMed  Google Scholar 

  45. Parolari A, Alamanni F, Naliato M, Spirito R, Franze V, Pompilio G, et al. Adult cardiac surgery outcomes: role of the pump type. Eur J Cardiothorac Surg. 2000;18(5):575–82.

    Article  CAS  PubMed  Google Scholar 

  46. Khoshbin E, Roberts N, Harvey C, Machin D, Killer H, Peek GJ, et al. Poly-methyl pentene oxygenators have improved gas exchange capability and reduced transfusion requirements in adult extracorporeal membrane oxygenation. ASAIO J. 2005;51(3):281–7.

    Article  CAS  PubMed  Google Scholar 

  47. Dogal NM, Mathis RK, Lin J, Qiu F, Kunselman A, Undar A. Evaluation of three hollow-fiber membrane oxygenators without integrated arterial filters for neonatal cardiopulmonary bypass. Perfusion. 2012;27(2):132–40.

    Article  CAS  PubMed  Google Scholar 

  48. Gu YJ, Boonstra PW, Graaff R, Rijnsburger AA, Mungroop H, van Oeveren W. Pressure drop, shear stress, and activation of leukocytes during cardiopulmonary bypass: a comparison between hollow fiber and flat sheet membrane oxygenators. Artif Organs. 2000;24(1):43–8.

    Article  CAS  PubMed  Google Scholar 

  49. Mongero L, Beck J. On bypass: advanced perfusion techniques. New York: Springer; 2008.

    Book  Google Scholar 

  50. Javidfar J, Brodie D, Costa J, LaVelle M, Miller J, Newmark A, et al. Subclavian artery cannulation for venoarterial extracorporeal membrane oxygenation. ASAIO J. 2012;58(5):494–8.

    Article  CAS  PubMed  Google Scholar 

  51. Wang D, Zhou X, Liu X, Sidor B, Lynch J, Zwischenberger JB. Wang-Zwische double lumen cannula-toward a percutaneous and ambulatory paracorporeal artificial lung. ASAIO J. 2008;54(6):606–11.

    Article  PubMed  Google Scholar 

  52. Vohra HA, Adamson L, Weeden DF, Haw MP. Use of extracorporeal membrane oxygenation in the management of septic shock with severe cardiac dysfunction after Ravitch procedure. Ann Thorac Surg. 2009;87(1):e4–5.

    Article  PubMed  Google Scholar 

  53. MacLaren G, Pellegrino V, Butt W, Preovolos A, Salamonsen R. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care. 2004;32(5):707–10.

    CAS  PubMed  Google Scholar 

  54. Maclaren G, Butt W, Best D, Donath S, Taylor A. Extracorporeal membrane oxygenation for refractory septic shock in children: one institution’s experience. Pediatr Crit Care Med. 2007;8(5):447–51.

    Article  PubMed  Google Scholar 

  55. Huang CT, Tsai YJ, Tsai PR, Ko WJ. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. J Thorac Cardiovasc Surg. 2013;146(5):1041–6.

    Article  PubMed  Google Scholar 

  56. Brechot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Leger P, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41(7):1616–26.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, 622 West 168th Street, PH 8-101, New York, NY, 10032, USA

    Cara L. Agerstrand MD

  2. Department of Clinical Perfusion, New York Presbyterian-Columbia University Medical Center, 4 Brook Row, Locust Valley, NY, 11560, USA

    Linda B. Mongero CCP, BS

  3. Department of Medicine, New York-Presbyterian Hospital/Columbia University Medical Center, 622 West 168th Street, PH 8 East, Room 101, New York, NY, 10032, USA

    Darryl Abrams MD & Daniel Brodie MD

  4. Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, 161 Fort Washington Ave, Room 336, New York, NY, 10032, USA

    Matthew Bacchetta MD, MBA, MA

Authors
  1. Cara L. Agerstrand MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda B. Mongero CCP, BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Darryl Abrams MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew Bacchetta MD, MBA, MA
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Brodie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cara L. Agerstrand MD .

Editor information

Editors and Affiliations

  1. Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, University of Iowa, Department of Internal Medicine, Iowa City, Iowa, USA

    Gregory A Schmidt

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this chapter

Cite this chapter

Agerstrand, C.L., Mongero, L.B., Abrams, D., Bacchetta, M., Brodie, D. (2016). Crises During ECLS. In: Schmidt, G. (eds) Extracorporeal Life Support for Adults. Respiratory Medicine, vol 16. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3005-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-3005-0_11

  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-3004-3

  • Online ISBN: 978-1-4939-3005-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation