Unexpected Air: An ECMO Discussion

Editor’s Note:

I was on FB and was visiting the Malaysian Perfusion Page, monitoring a discussion regarding venous air entrainment in an ECMO circuit, and the efforts made to save the patient. This a true emergency, and with a closed system, much more difficult to resolve.

The discussion however is what captured my interest because in it- are so many of the factors we deal with in the split seconds we have to make life altering (for the patient as well as the perfusionist) choices. Captured is well, is the the uncertainty we face, raw emotions, and of course- the second guessing.

See what you think- and add your own perspective?

Much luck to the patient and KUDOS to an honest perfusionist who didn’t quit. It takes humility and courage to share an experience such as this, and in the long run- it benefits us all.

-Frank

Unexpected Air: An ECMO Discussion

Azeli Shah Abas

22 hrs

“Today, an incident occured to our PLS Ecmo VA for a pediatric patient. Massive air bubble from venous due to disconnection of a vent attached to the venous cannula. I was not aware of it until my colleague suddenly stop the pump and immediately clamp both lines. I was annoyed with him when he told me to look at the pump head. It was half full with air bubbles.

I was shocked for 10 seconds (I think it was too long) to start thinking what to do. I asked the surgeon to fill up the venous line and quickly I aspirate the air from the pre membrane oxygenator side. I asked my colleague to detach the pump head from the pump and deair the bubbles towards the oxygenator. When the pump head is clear, we attached the pump head and connect 1 bag of normal saline after the pump head.

I open the the recirculation line, clamp both lines and start recirculation. The surgeon started to yell at us and I just tell to give us a minute. We need to recirculate until it’s clear.

When it’s clear, then we continued with the circulation. It took about 4 minutes of all the process including the shock reaction.

The patient is fine…and indeed…it’s one of the few days..”

Comments

Seen by 30

You, Dady Rayyan’s, Zikriel Hakeem, Kamarul Zaman and 14 otherslike this.
Circuit Surfers You did all that you could do- and didn’t quit- smile emoticon

21 hrs · Like
Ahmad Hairi Muhammad When the bad things happend, then they will search for perfusionist again.

17 hrs · Like · 1
Ahmad Hairi Muhammad All the 4 minute will disappear. Huh..

17 hrs · Like
Zuraini Mdnoor Hermi Miey

16 hrs · Like
Akuidup Dalam Blues Good job

13 hrs · Like
Marran Mani Well done. In perfusion, u dont have to memorize many things like doctors or any protocol / SOP to refere at that point of time but if u cannot solve a problem very quickly then the pt die. That’s why a perfusionist must be a PROBLEM SOLVER rather than vocalist

12 hrs · Like
Kamarul Zaman Compare with close n open system..in close system we need super reactive n creative method with a lower risk of pt get systemic embolism compared to open system..

What u write already can make an emergency sop write up for air embolism.good job kipidap

11 hrs · Like
Ishaker Aw Day dream unlike nite sweetie memory. Happen to every body but salute for an effort make the thing right. Close neurological assessment may be required for late adverts. Well done but just wonder why vent on VA ECMO.!

8 hrs · Like
Azeli Shah Abas It’s normal to daydream during ecmo since its not as vigilance as normal cabg cpb. I was doing documentation at that time while talking to the nurses.

Its just an emergency VA Ecmo for myocarditis baby and not for open heart surgery. The baby just need cardiac support.

4 hrs · Like
Akuidup Dalam Blues Tunjuk ajar ku sifuuuuu

4 hrs · Like
Zikriel Hakeem How did u prime back the vent line?

3 hrs · Like
Zikriel Hakeem Do we need to fill up the heart a bit to prime the vent line?

3 hrs · Like
Azeli Shah Abas It’s an ECMO and it’s close circuit. We cannot fill up the heart. The vent goes to the LA suck back to the venous line. They deair the vent and filled the tube with saline and connect it to the venous line via 3 way connector.

5 mins · Like