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The ELSAphant in the Room

By Daniel Foster03 May 2024

The practical benefits of TTFM are obvious for CABG. The patient’s life depends upon graft flow, and TTFM is the only way to accurately check that flow. The benefits of ELSA are more subtle, but make no mistake, they are every bit as imperative. For example…

The tech, Tanner, shifted uncomfortably, his study materials on the table, forgotten. He shone the flashlight through the oxygenator again. Red blood moved quietly past, but the darkening mass in the center leered at him. He glanced at the patient. Her life was his responsibility, and the dark red, angry-looking mass in the oxygenator was making that responsibility heavier by the moment. He pulled out his cell. It was 2:13AM. He’d already awakened the perfusionist once that night. He bit his lip and dialed anyway.

The perfusionist was a mile down in sleep when her cell phone screamed in her ear. A mug tumbled off the nightstand as she groped for the phone.

“Hello?” she croaked into the phone.

“It’s me,” Tanner replied.

She gritted her teeth. How long had it been since she’d slept through the night?

“I could swear that clot is bigger than when I came on shift,” he said.

She blinked owlishly. Wha…? Right, Carson, the only patient on ECMO. The perfusionist felt like she was pushing her thoughts through mud. Carson is scheduled for a trial of wean tomorrow. If I tell them to do an oxygenator change, it’ll push that back two days. D**** it.

“Is the patient symptomatic?” she asked.

“Not yet.” he replied. “But I could swear it’s bigger. I think it’s growing back away from me towards the center.”

She looked down at herself and found that she’d fallen into bed in her scrubs. Gross. “I’ll be there in ten,” she sighed. Outside, the night air was brittle with cold, as if it might shatter into frosty shards if she spoke. She did the drive in seven minutes.

The circuit changeout, however, took quite a bit longer. Tanner stood by the entire time, looking down in embarrassment, trying to help without getting in the way. “Tanner, I agreed with you,” the perfusionist said. “You don’t have to feel bad about it.”

“But neither of us were sure, and now we can’t wean the patient for at least a couple more days” he replied helplessly.

“Better safe than sorry.” She sighed inwardly. And that’s always the way.

* * *

Now, let’s reconsider the same scenario, adding only an ELSA meter.

Tanner settled back comfortably, turned a page in his study material, and glanced at the oxygenator again. It looked like the clot may have grown since his shift began. Hmm. It’s probably getting close to time for my check anyway.

The perfusionist, who was sleeping soundly, had allowed them one PRN Oxy check with the ELSA per shift. All they had to do was take the measurement, account for the patient’s hypovolemic status, document the bolus in the I&O record, and note the OXBV in the patient’s chart. If it had changed significantly (as identified by hospital’s ECMO protocol), then Tanner would know for sure he needed to call the perfusionist.

Twenty-five minutes later, Tanner skimmed back through the last few days of ELSA measurements. The trend was normal: a slightly decreasing OXBV (i.e. slightly increasing clotting): 78% OXBV at the beginning of the week, then 76% two days later, now its 75% with the measurement he’d just taken. The patient was asymptomatic, so he knew all was well.

Tanner gathered up his study materials again. He was pleased to see that he was more than halfway through. The perfusionist would get a full night’s sleep. The patient’s trial of wean would happen as scheduled and the hospital would save nearly $25,000 in the process. But Tanner didn’t know any of that. He only knew that the patient was safe, and he’d be more than ready for his practicum.

Find out how the ELSA can change your entire outlook on ECMO. Click here