Fig. 1
From: How I approach membrane lung dysfunction in patients receiving ECMO
Algorithmic approach to membrane lung monitoring for membrane lung dysfunction. Cut-off values for consideration of ML exchange are suggested values based on author experience and should be considered in the context of the patient and dependence on ECMO support. Please refer to text for details. ML, membrane lung; Plt, platelet count; INR, international normalized ratio; aPTT, activated partial thromboplastin time; fHb, free hemoglobin; LDH, lactate dehydrogenase; ΔP, Pressure drop across the ML; PPre, pre-ML pressure; PPost, post-ML pressure; RML, resistance within the ML; BFR, blood flow rate; V′O2, membrane lung oxygen uptake; CPreO2, O2 content of pre-ML blood; CPostO2, O2 content of post-ML blood; PPreO2, partial pressure of pre-ML O2; PPostO2, partial pressure of post-ML O2; PPreCO2, partial pressure of pre-ML CO2; PPostCO2, partial pressure of post-ML CO2. Flowchart is designed with adult ECMO patients in mind and may not be applicable to pediatric or neonatal patients. *Extent and frequency of coagulation and hemolysis lab monitoring is not well-established and will vary by center. Not all labs are required to diagnose coagulopathy or hemolysis. **When a ML fails, we recommend considering switching the entire circuit, rather than just the ML, if: (a) the ML and pump head are fused; (b) the ML dysfunction occurs in the setting of circuit-related coagulopathy; or (c) the ML dysfunction occurs in the setting of an older circuit (i.e., longer than 2 weeks). While the first is due to technical limitation, the latter aim to reduce the risk of ongoing or new circuit-related coagulopathy in circuits at risk for this phenomenon