How I manage drainage insufficiency on extracorporeal membrane oxygenation

Fibrin and Drainage Insufficiency on Extracorporeal Support: What Came First?

“…The sleeve, occluding some of drainage holes or drainage hole rows, may have decreased the inlet pressure at the level of the unobstructed holes. The lower inlet pressure (augmented negativity) would have increased the risk of collapse of the IVC on the cannula, arising drainage insufficiency, with swinging inlet pressure, drainage tubing “chattering,” and inconsistent EBF, 3 without any other evident cause and any substantial response to fluid challenge.…”

“…LETTERS TO THE EDITOR e472 of collapse of the IVC on the cannula, arising drainage insufficiency, with swinging inlet pressure, drainage tubing "chattering," and inconsistent EBF, 3 without any other evident cause and any substantial response to fluid challenge.…”

“…Excessively negative drainage pressure, resulting in our case from increased inflow resistance, is among the common potential determinants of drainage failure. 3 The cannula (23 Fr) was not undersized for the small patient (body surface area 1.59), requiring an ECLS mainly aimed to support CO 2 removal, with a relatively low target EBF (median 3.2 liters per minute, interquartile range 0.3). 3 Proper position of the cannula was confirmed by both radiographic and ultrasound imaging techniques, the latter also demonstrating collapsed IVC, particularly on transhepatic view.…”

“…3 The cannula (23 Fr) was not undersized for the small patient (body surface area 1.59), requiring an ECLS mainly aimed to support CO 2 removal, with a relatively low target EBF (median 3.2 liters per minute, interquartile range 0.3). 3 Proper position of the cannula was confirmed by both radiographic and ultrasound imaging techniques, the latter also demonstrating collapsed IVC, particularly on transhepatic view. No evidence of clots was noticed around the cannula, nor cardiac tamponade and pneumothorax were diagnosed.…”

Impaired Blood Flow? Tension Pneumothorax on Extracorporeal Support

“…In patients requiring extracorporeal support due to acute respiratory distress syndrome, particularly in the COVID-19 population, known to be at high risk of barotrauma, 1,2 an acute decrease in the ECMO inlet pressure (increased negativity), 3,4 deteriorating EBF, compromizing therapy effectiveness, and increased post-membrane lung (return) pressure may suggest acute development of clinically significant pneumothorax, or significant worsening of preexisting pneumothorax, requiring prompt intervention to restore cardiovascular physiology and decrease intrathoracic pressure, allowing for EBF to be early reestablished. 5…”