Flow Monitoring of ECMO Circuit for Detecting Oxygenator Obstructions

Sarathy, Srivats; Turek, Joseph W.; Chu, Jian; Badheka, Aditya; Nino, Marco A.; Raghavan, Madhavan L.

doi:10.1007/s10439-021-02878-w

Cited by 6 publications

(5 citation statements)

References 10 publications

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“…2 ). 26 There appears to be some variability between repeated experiments, and there was also no investigation into how clot location affected pressure drop.…”

Section: Current Clot Detection Methodsmentioning

confidence: 99%

“…Following a similar study by Badheka et al, 61 Sarathy et al investigated how shunt flow monitoring could predict oxygenator obstruction. 26 A derived mathematical model indicated that as pressure drop in the oxygenator increased, the flow rate within the shunt should increase linearly. They showed that this flow rate should also linearly increase with rising cannula resistance.…”

Section: Currently Proposed Solutions To Oxygenator Clot Detectionmentioning

confidence: 99%

See 1 more Smart Citation

Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions

Leerson,

Tulloh,

Lopez

et al. 2023

Semin Thromb Hemost

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Extracorporeal membrane oxygenation (ECMO) is a life-support technique used to treat cardiac and pulmonary failure, including severe cases of COVID-19 (coronavirus disease 2019) involving acute respiratory distress syndrome. Blood clot formation in the circuit is one of the most common complications in ECMO, having potentially harmful and even fatal consequences. It is therefore essential to regularly monitor for clots within the circuit and take appropriate measures to prevent or treat them. A review of the various methods used by hospital units for detecting blood clots is presented. The benefits and limitations of each method are discussed, specifically concerning detecting blood clots in the oxygenator, as it is concluded that this is the most critical and challenging ECMO component to assess. We investigate the feasibility of solutions proposed in the surrounding literature and explore two areas that hold promise for future research: the analysis of small-scale pressure fluctuations in the circuit, and real-time imaging of the oxygenator. It is concluded that the current methods of detecting blood clots cannot reliably predict clot volume, and their inability to predict clot location puts patients at risk of thromboembolism. It is posited that a more in-depth analysis of pressure readings using machine learning could better provide this information, and that purpose-built imaging could allow for accurate, real-time clotting analysis in ECMO components.

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“…2 ). 26 There appears to be some variability between repeated experiments, and there was also no investigation into how clot location affected pressure drop.…”

Section: Current Clot Detection Methodsmentioning

confidence: 99%

Section: Currently Proposed Solutions To Oxygenator Clot Detectionmentioning

confidence: 99%

Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions

Leerson,

Tulloh,

Lopez

et al. 2023

Semin Thromb Hemost

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“…The retrospective study by Lubnow et al emphasized the importance of early identification of oxygenator dysfunction during prolonged ECMO use. DD levels raised from 15 (9-20) to 30 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) mg/dL within 3 days before exchange and declined significantly within 1 day thereafter to 13 (7-17) mg/dL. The rise in plasma D-dimer concentration, in the absence of other factors, was identified as a helpful predictor for membrane oxygenator (MO) exchange in heparin-coated ECMO systems.…”

Section: D-dimersmentioning

confidence: 99%

“…Their results demonstrated that higher levels of oxygenator obstruction led to a measurable increase in shunt flow. This suggests that flow monitoring could be a promising approach to identifying obstructions, offering an alternative to pressure-based monitoring [26].…”

Section: Flows and Pressuresmentioning

confidence: 99%

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

Butt,

Razzaq,

Saleem

et al. 2024

J Extra Corpor Technol

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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 circuit 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 in 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 safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.

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“…Additionally, monitoring the pressure drop between pre- and post-oxygenator measurements at a constant flow rate can assess clot formation within the oxygenator. [ 89 ] Besides the coagulopathy-related reasons, neurologic injury may be caused by a sudden increase in blood PaO 2 , decrease in blood PaCO 2 , and disease-related variables (including prolonged severe hypoxia and pre-ECMO cardiac arrest). To detect neurologic injury, multimodal neurologic monitoring (neurologic examination, near-infrared spectroscopy, electroencephalography, cerebral ultrasound, biomarkers, and neuroimaging) is beneficial.…”

Section: Special Issues During Ecmo Managementmentioning

confidence: 99%

Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

Zhang,

Xu,

Huang

et al. 2024

Journal of Intensive Medicine

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Flow Monitoring of ECMO Circuit for Detecting Oxygenator Obstructions

Cited by 6 publications

References 10 publications

Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions

Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions

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

Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

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