9, 8, 31, 32, 33, 34, 35, 38
Provides the only quantitative membrane-exchange threshold this book has found (150 mL/min oxygen transfer), the pressure-localisation rule that turns a low-flow alarm into a located diagnosis, and the two-team crisis principle. Directly contradicts several habits: reaching for the hand crank in low-flow events, and stocking blood in the room.
None — textbook chapter
Structured response to circuit malfunction and crisis
Textbook chapter; recommendations are expert consensus, not graded evidence. The 150 mL/min threshold is cited to a single reference that was not retrieved and has not been validated against outcomes — see Butt 2024, which finds no validated change-out criteria. Figures 7-5 and 7-6 are algorithm diagrams whose content was inferred from surrounding text, not read directly. Publication year of the 6th edition not independently confirmed in this session.
Supplies most of Chapter 9's operational content. Access insufficiency is the commonest cause of sudden flow reduction at constant pump speed. Pressure pattern localises obstruction: drainage more negative = between drainage cannula and pump inlet; pre- and post-membrane rising by similar amounts = between membrane lung and return cannula; widening delta-P = within the membrane lung. Abrupt loss of gas exchange means gas supply interruption, because membrane decline takes hours to days — assess pre/post membrane blood colour first. Hand crank indications are loss of power and console failure ONLY; exclude flow probe malfunction first. Circuit troubleshooting personnel must be separate from patient-management personnel. Blood products in the room are "excessive and unnecessary"; crossmatched blood in the bank plus a massive transfusion protocol giving at least 4 units uncrossmatched immediately is what is required. Membrane lung exchange should be considered when oxygen transfer is below 150 mL/min. Circuit air is "nearly always avoidable"; bubble sensor placed before the membrane lung alerts earlier.
All ECLS patients