ECMO-/ECLS

higher PEEP during the course on extracorporeal support has been
demonstrated to decrease the duration of ECLS.[ 13 ] Since only partial bypass is
utilized, oxygenation and carbon dioxide elimination are determined by a
combination of native lung function as well as extracorporeal flow. The mixed
venous oxygen saturation (SvO2) is frequently monitored allowing determination
of the adequacy of oxygen delivery in relation to oxygen consumption. Pump flow
is adjusted to maintain oxygen delivery such that the SvO2 is in the 60-75%
range.
Heparin is administered to prevent thrombus formation throughout the
ECLS course. The level of anticoagulation is monitored hourly by whole blood
ACT, maintained between 170-230 seconds (normal is approximately 100
seconds).[ 14 ] In the setting of active hemorrhage, although circuit thrombosis is
inevitable, temporary discontinuation of systemic heparin administration is not
only feasible but a better alternative to withdrawal of ECLS. A primed circuit is
kept available whenever the ACT is maintained less than 160 seconds. Heparin
and other agents, including nitric-oxide, aprotinin, iloprost, and tranexamic acid,
have been used to coat circuits to prevent thrombus formation and continue to be
evaluated in laboratory and clinic settings .[ 5 ]
Depending on underlying physiology, transfusion of red blood cells, fresh
frozen plasma, platelets, cryoprecipitate to maintain appropriate targets is
frequently required. Therefore, laboratory values, specifically hemoglobin, INR,
platelets, fibrinogen and other electrolytes, are routinely monitored and corrected
as needed. Chest x-rays are routinely performed to check position of the