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Review
. 2024 Mar;56(1):20-29.
doi: 10.1051/ject/2023047. Epub 2024 Mar 15.

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Salman Pervaiz Butt  1 , Nabeel Razzaq  2 , Yasir Saleem  3 , Bill Cook  4 , Salman Abdulaziz  5
Affiliations
Review

Improving ECMO therapy: Monitoring oxygenator functionality and identifying key indicators, factors, and considerations for changeout

Salman Pervaiz Butt et al. J Extra Corpor Technol. 2024 Mar.

Abstract

Introduction: The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy.

Methodology: A thorough search of relevant studies on ECMO circuits and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria.

Discussion: Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects of this process.

Conclusion: In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve the safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.

Keywords: Circuit Change out; Extracorporeal membrane oxygenation (ECMO); Key Indicators; Monitoring.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart A: Illustration of Factors to be considered before ECMO circuit/oxygenator change-out.
Figure 2
Figure 2
Flow Chart B: Illustration of standard operating procedure of ECMO circuit change-out.
See this image and copyright information in PMC

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