Extracorporeal membrane oxygenation (ECMO) is a treatment for critically ill pediatric patients that blends the best of cutting-edge technology with compassionate, expert care from a cross-disciplinary medical team. The results can be life-changing and life-saving. 

Despite the many benefits of ECMO for children facing severe respiratory or cardiac threats, it is not without challenges. For instance, recirculation can affect the delivery of oxygenated blood and impact patient outcomes.

There are several possible causes for recirculation during venovenous (VV) ECMO therapy, including cannula migration or misplacement. Accurate measurement of true blood flow is critical for identifying potential cannulation issues.

Here’s how the Transonic ELSA (Extracorporeal Life Support Assurance) Monitor can be used by critical care intensivists and other medical professionals to confirm recirculation and optimize cannula placement during ECMO treatment for pediatric patients.

Recirculation Measurements & Cannula Placement

Cannula placement and delivered blood flow are closely linked.

A VV ECMO pump delivers blood flow at a specified rate set by an intensivist. However, if that flow volume (or part of it)  is misdirected, oxygenated blood may recirculate back into the ECMO circuit before it enters the patient’s circulatory system.

Identifying the presence of recirculation during ECMO therapy provides vital information about the patient and their treatment, indicating that the intended amount of oxygenated blood is not being circulated properly through the patient.

Recirculation measurement at the time of cannulation will tell the intensivist if the cannulation placement is acceptable or if it needs adjustment. For instance, if the venous cannula is stuck against the wall of the inferior vena cava, blood flow may be restricted or redirected.  

Initial data about recirculation also provides a baseline for future determination of whether the cannula has moved and can be used to help optimize subsequent cannula positioning.

Measuring Recirculation With the ELSA Monitor

Combined in one stand-alone monitor, these technologies provide care teams with key quantitative data that can make a real difference in the care of critically ill children.

Knowing the exact percentage of recirculation during VV ECMO allows the intensivist to make on-the-spot adjustments and, if necessary, correct cannula misplacement.

If recirculation is present and the intensivist confirms that the cannulas are positioned correctly, the information is useful to indicate other possible issues with blood volume or cardiac function.

In addition to recirculation, the ELSA Monitor measures both delivered blood flow and oxygenator blood flow.

Learn more about the benefits of the ELSA Monitor for pediatric patients.