🔹 Webinar Focus: Oxygenator Failure & Crisis Management

  • Analogy: Treat oxygenator failure like cardiac arrest – act fast.

  • Failure signs:

    • Drop in SpOâ‚‚ and MAP, increased agitation.

    • Dark return blood, rising delta pressure (pre/post membrane).

  • Diagnosed using:

    • Blood gases (low PaOâ‚‚, high PaCOâ‚‚, acidosis).

    • Pressure gradients (pre/post membrane).

    • Biochemical markers (↑free Hb, LDH; ↓platelets, fibrinogen).

🔹 Management Protocol

  • Prioritize systemic oxygen delivery before oxygenator exchange.

  • Initiate exchange protocol: ventilator support may be temporarily increased.

  • Ensure clear role delegation among team members:

    • ECMO specialist: Prepare circuit.

    • ICU nurse: Monitor/support patient.

    • Intensivist: Lead, coordinate.

    • Perfusionist: Assist circuit exchange.

  • Team debriefing post-event is critical for improvement and safety.

🔹 MCQ Highlights

  • Dark return blood is the early warning sign of oxygenator failure.

  • Most reliable indicator: rising pre/post membrane pressure gradient.

  • Key action before exchange: call for emergency change, not reduce pump speed.

  • After exchange: document, debrief, and analyze system/process.

🔹 Additional Key Points

    • Acute deterioration → Immediate action.

    • Gradual dysfunction → MDT discussion.

      Crisis vs. elective oxygenator exchange:

  • VV ECMO patients can tolerate longer periods without anticoagulation.

  • Circuit changes may carry risks; balance decisions with clinical context.

  • Oxygenator failure causes:

    • Thrombosis (most common), plasma leak, sweep gas issues.

🔹 Educational Emphasis

  • Simulation-based training is essential (like ACLS, PALS).

  • Ongoing education, protocols, drills, and crisis preparedness must be embedded in practice.

  • Future sessions will include realistic simulation training to improve crisis response.

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