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Measurements That Matter in ECMO Pediatrics Care

By Kiele Hayes Rigaud07 Jun 2023


Children receiving extracorporeal membrane oxygenation (ECMO) treatment are some of the most critically ill patients, experiencing severe respiratory or cardiac failure.

Careful monitoring is required from highly specialized medical professionals to ensure the best outcomes for these patients. That involves both hands-on care and surveillance of the patient’s general condition and response to treatment.

In addition to clinical observations, certain measurements taken with ultrasound indicator dilution and transit-time ultrasound technology can provide added information that makes a difference in the care of ECMO pediatric patients.

These are two measurements that matter in ECMO pediatric care.

Oxygenator Blood Volume  

One possible complication with ECMO therapy is clotting in the oxygenator. Fine balance is required to minimize oxygenator clotting while controlling the possibility of bleeding.

There is no “one size fits all” solution for avoiding clot formation in ECMO therapy. Measuring oxygenator blood volume helps perfusionists and ECMO specialists quantify decreases in oxygenator performance, which may be indicative of clot formation in the circuit, allowing for early detection and a wider window of opportunity to react. Please note that ELSA does not measure clot formation in the oxygenator, but rather gives data that can support clinical decisions.

Trending the increased burden and decreased efficiency allows a specialist, for example, to plan for and schedule changing out the oxygenator as clinically needed.

Transonic’s Extracorporeal Life Support Assurance (ELSA) monitor measures the circuit proximal and distal to the oxygenator. Room temperature saline is injected near the oxygenator inlet and the ELSA Monitor measures oxygenator blood volume between the injection site and the arterial sensor. A clot in the oxygenator will show a decrease trend in OXBV value; as clot volume increases, oxygenator blood volume decreases.

The results for each injection are shown on a timeline, with various trending curve intervals available to help clinical teams predict when an oxygenator change-out will be necessary.


Recirculation in the circuit can compromise the delivery of oxygenated blood.

With a single bolus of saline, the Transonic ELSA Monitor detects and quantifies recirculation, giving the intensivist vital information that supports patient care. ECMO pumps are set to deliver a specific rate of blood flow, and the ELSA Monitor confirms whether that rate of flow is being delivered to the patient or being recirculated.  

For example, a 50 percent recirculation measurement indicates that half of the intended oxygenated blood is not being circulated through the patient. This number of 50 percent is highly unlikely even in extreme cases and simply used for illustrative purposes. High recirculation during ECMO treatment could indicate a number of serious complications including cannula misplacement, hypovolemia or cardiac failure.

Previously, care teams were not able to easily and quickly quantify the amount of recirculation. Having data and known values is important because it helps intensivists identify complications and improve treatment by configuring optimal pump settings, optimizing cannula placement, and identifying complications like cardiac failure.

Flow Measurement Solutions for ECMO

Transonic’s ELSA Monitor helps the patient’s care team make these critical measurements using ultrasound indicator dilution and transit-time ultrasound technology.

The stand-alone monitor is portable, easy to clean and has an intuitive touchscreen interface for ease of use.

Quantitative data is available in real-time, at the patient’s bedside, and can be used by the team to optimize treatment and care for pediatric patients.

Learn more about the benefits of the ELSA Monitor for ECMO pediatrics.

Learn Why Every Pediatrics Unit Needs ELSA for ECMO Support