37: Extracorporeal Membrane Oxygenation Circuit Challenges and Troubleshooting - Our Experience

Introduction: Our institution is a referral centre for complex cardiac surgeries for both the adult and pediatric population in India. We perform nearly 6,000 cardiac surgeries and ECMOs ranging from 120-150 per year. ECMOs indications comprise medical, bridge to transplant and post-cardiotomy of cardiac cases. ECMO’s role is crucial in saving lives especially when we have terminal ill patients getting referred to a tertiary care like ours. The objective is to share our experience in ECMO Circuit challenges & complications, Oxygenator and Circuit changes and its trouble shooting. Methods: Being a high-volume centre, we have performed around 1,445 ECMOs since 2004. During this long tenure we performed many circuit changes and have come across several ECMO related complications such as oxygenator failure, clots in the circuit, pump head failure, and air entrainment in the circuit etc. We have analyzed the last 5 years of data and would like to share it with everyone. Results: In our study, most observed ECMO complications and circuit troubleshooting are as follows: There were total of 24 Oxygenator change out. 3 cases of circuit change. There were 7 Pump off events (Pump failure) and 3 patients needed re-initiation of ECMO. Conclusions: ECMO runs involves complications and challenges which can be handled in an appropriate way by following strict safety protocols and standard operating procedures (1). Regular wet labs, mock drills and troubleshooting scenarios have helped our large volume ECMO centre to yield favorable results. Our ECMO experience has given us immense knowledge on tackling challenges, anticipate problems and has formulated us to implement new strategies to counter these problems better.