Chattering on ECMO
What is chattering? If you look closely at this video clip, the tubing is moving ever so slightly. This is due to a mismatch between circuit volume (which is low) and pump circuit pressure (which is high) resulting in turbulence in the system. A common fix is volume repletion. Some of these patients needs 3-4L at a time. Albumin is also administered. Another fix is to lower the RPMs. While doing these things, also investigate WHY the patient could be losing volume. Is it because of bleeding? True hypovolemia?
Complications of untreated chattering are worsening hypoxemia due to decreased flow through the ECMO circuit. Additionally, excessive negative pressure in the drainage cannula can potentially injure red blood cells and cause hemolysis. Consider checking haptoglobin and LDH when you see this occur.

Dr. Komal Parikh @pulmcritdoc

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