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.
Unexpected Air: An ECMO Discussion
“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..”