8, 9, 32, 37, 55
Provides the operational numbers for the daily circuit round in the absence of trial evidence. Both flow extremes are unsafe: too negative causes haemolysis, too low causes stasis and thrombosis.
None — textbook chapter
Routine daily circuit surveillance
Textbook chapter, 2017; recommendations are expert practice, not graded evidence. Editors, publisher and page numbers not verified in this session and deliberately not stated. The ~50% RRT figure may not reflect current practice. Project-library PDF text has previously been shown to contain at least one transcription error in a numerical convention, so figures from it are treated as requiring confirmation.
States the working thresholds used throughout Chapter 8: pre-pump (access) pressure ideally around −60 mmHg, with pressures more negative than −100 mmHg increasing blood trauma and free haemoglobin release; blood flow through any tubing should not fall below 1.5 L/min (authors advocate ≥2, usually ≥2.5); circuit blood gases must be drawn with sweep at 100% oxygen for comparability; transmembrane pressure (pre minus post) trended alongside post-oxygenator gases predicts oxygenator failure and converts an emergency change into a planned one; heat-exchanger failure occurs in ~2% and is frequently misattributed to the patient; ~50% of patients require RRT; sedation interruption is easier on ECMO because drive is controlled by CO₂ removal, and neurological assessment is "a key step in ensuring that ECMO is not futile."
Adult ECMO patients