VV ECLS ALGORITHM

SvO2 < 75
SpO2 < 90

ASSESS SvO2 & SpO2

SvO2 75-85
SpO 2 85-95

Increase ECMO flow

SvO2 > 85

Decrease ECMO flow

SpO2 >98

Unable to
Increase flow
Exclude :

low
Reposition patient
Raise bed (roller)

Assess CO
Reposition patient
Reposition cannula

ASSESS CO

Venous cannula obstruction / kink

Pain / anxiety / increased consumption

SpO2 < 85

high

Assess volume status

normal
fluid overload diurese
pain / anxiety.analgesia/sedation
idiopathic
vasodilator

normal / high

low
INOTROPE
? HYPOVOLEMIA
BP/CVP
Pulse pressure
Perfusion
Urine output
Tachycardia

ASSESS HAEMATOCRIT
yes

< 25 %

> 25 %

no
Transfuse
Packed rbcs

no action required
OR volume if hypovolemic
- platelets
- fresh frozen plasma
- albumin
- crystalloid

IF EUVOLEMIC
? TAMPONADE / TENSION PNEUMO- or HAEMOTHORAX
-High SvO2 (recirculation) / low PaO2
-Falling circuit flow
-signs of low CO ( small pulse pressure, poor perfusion, tachycardia)
? VENOUS CANNULA OBSTRUCTION
-Freq cut-out (roller)
-High negative access P (Biomedicus)
-High BP

VV ECLS MANAGEMENT ALGORITHM

SvO2 = measured mixed venous oxygen sat in circuit : Always some recirculation, so reads higher than true
SpO2 = patient peripheral oxygen saturatio

Policy #

BCCH Child & Youth Health Policy and Procedure Manual

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