32, 30, 31, 87, 88, 89, 92
The field has a list of what to measure and no protocol for what to do with it, so any integrated reading of membrane lung function is assembled locally and should be written down as such. The measurement most likely to give early warning — continuous exhaust carbon dioxide — exists on some devices and has not been prospectively evaluated. And the asymmetry between a 15 to 30 minute preparation and a sub-2-minute swap is the practical reason surveillance matters: it does not shorten the procedure, it moves it into working hours.
Not applicable
DOI 10.1051/ject/2026022; PMID 42743428; PMC13577623
Not applicable — appraisal of current monitoring practice and of the case for an automated clinical decision support system
The literature component applied no formal inclusion or exclusion criteria and no quality assessment framework, by the authors' own statement. THE INTERVIEW COMPONENT IS A MARKET-DISCOVERY INSTRUMENT RATHER THAN A CLINICAL PRACTICE SURVEY: of 45 stakeholders, 15 were from sales and business and a further 10 were scientists or biomedical engineers, leaving 20 clinicians of any kind; recruitment was largely by web search and referral with 58 percent from a single US state. The ELSO recommendations are reproduced here at second hand and the guideline text itself was not retrieved. Its pain points should be read as hypotheses about what clinicians find difficult rather than as evidence of what they do.
Summarises ELSO gas-exchange monitoring recommendations as: continual arterial and venous blood gas monitoring; pre-membrane and post-membrane blood gas analysis daily; regular checking of the membrane lung pressure gradient; monitoring of blood flow; maintaining adequate haemoglobin; and monitoring lactate. THE KEY STATEMENT: no unified protocol exists specifying how these parameters should be integrated or recorded to characterise overall circuit gas-exchange efficiency. Measurement of oxygen and carbon dioxide concentrations within the sweep gas helps determine uptake and clearance and is available on some devices, but MANY MEMBRANE LUNGS LACK INTEGRATED SENSORS FOR POST-MEMBRANE OXYGEN PARTIAL PRESSURE AND SATURATION. Two published continuous gas-exchange monitoring approaches — an algorithmic one and a sensor-based one using two oximetry probes, an ultrasonic flow meter and infrared exhaust carbon dioxide — are described as not widely adopted because of modelling complexity, extra sensors and workflow interruption. Console flow and pressure data are typically recorded manually only once or twice an hour into the record. OPERATIONAL FIGURE: clinicians described preparation for a membrane lung swap taking about 15 to 30 minutes or longer, while the swap itself typically takes under 2 minutes, during which the patient loses ECMO support. Haemolysis and debris in the membrane lung are currently assessed visually with a flashlight, which interviewees described as not always accurate. The authors note it is not conclusive whether current clinical decision support systems improve patient outcomes, and list skill atrophy, mode confusion and automation bias as risks.
Two components: an unsystematic literature review of ECMO circuit monitoring (no inclusion criteria or quality assessment framework applied, by the authors' own statement), and a customer-discovery interview study of 45 stakeholders in the United States and Canada conducted September to October 2023