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How to Limit Complications From ECMO

By Kiele Hayes Rigaud02 Aug 2023

No matter how tested-and-true a treatment may be, complications can always arise.

Many patients in the modern world owe their lives to ECMO. Extracorporeal membrane oxygenation has provided life-saving support for countless critically ill infants, children, and adults.

ECMO is often the last line of defense for life-threatening respiratory or cardiac distress. However, despite ECMO’s inestimable value, and despite how many lives it has saved, it is not without risk.

Potential complications from ECMO can range from simple bleeding to complete cardiac failure and death. Fortunately, careful monitoring with the right tools can not only reveal a host of hidden problems, but can also give you a window in which to take a potentially life-saving action.

So the question remains: what is this miracle tool, and how does it work?

Well, its name is as straightforward as its operation: the Transonic ELSA Monitor. But you’re a clinician, and you want to know a lot more than a brand name before you make a decision…


That is the million-dollar, potentially life-threatening question. An ECMO patient is already critically ill, and they need every advantage we can give them, so minimizing systemic inflammation (which occurs every time we change the oxygenator) is a must.

So changing out the oxygenator too soon or too often is an unnecessary burden on hospital resources, the care team, and the patient.

Changing it too late is even worse.

However, it’s not always possible to see what is going on inside of the oxygenator to verify clot formation. Even if that was possible, the presence of clotting doesn’t necessarily equal patient decompensation. Data provides a better picture of the patient’s status, so the care team can react accordingly.

The ELSA Monitor empowers you to choose the perfect time to change the oxygenator for each patient’s case, and gives you the forewarning to plan ahead. No more emergent changes at 2AM when all your staff are gone.

How does it work? Room-temperature saline is injected in an inlet between the pump and the oxygenator, and then the ELSA monitor measures the oxygenator blood volume between that injection site and the arterial sensor. A decrease in oxygenator efficiency can be visually observed as a trending decrease in oxygenator blood volume.

Trended curves (data over 4 hours, 24 hours, or total case-time) help you optimize your patient care by changing exactly when your patient needs it. Not before, and not after.  

Recirculation Problems

Recirculation data tells an important story about the effectiveness of a patient’s ECMO therapy.

Recirculation robs your patient of precious oxygen. That is, in the presence of recirculation, the rate of flow set by the intensivist is not being achieved, and there is not a single cell in the patient’s already-compromised body that can survive without oxygen.

There are various causes for recirculation (cannula misplacement, hyper- or hypovolemia, etc.)

but you can correct most of them–if you’re aware of them. The ELSA Monitor can detect and quantify recirculation using a single bolus of saline. There’s no more simple way to gain such powerful information. When minutes matter, ELSA empowers you with information: what you want to know, when you need to know it.

To measure is to know and, with ECMO therapy, that can make all the difference.

Learn Why Every Pediatrics Unit Needs ELSA for ECMO Support