Critical Matters ECMO Emergencies
Feb 12, 2026
Dr Waqas Akhtar, consultant in cardiology and intensive care who led the British guideline on ECMO emergencies. He discusses why ECMO emergencies matter, differences between VA and VV support, a two-team response model, rapid circuit troubleshooting, flow-based management, training needs, and service design pearls. Practical, focused, and action-oriented.
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Clear Activation Criteria
- Trigger an ECMO emergency when unresponsive plus a confirmed MAP <30 mmHg, sudden fall in end-tidal CO2 trend, or loss of ECMO flow.
- Confirm arterial line zeroing and transducer function before declaring low MAP.
Use Adrenaline Only With ECMO Expertise
- Defer routine adrenaline boluses until an ECMO expert assesses the cause since adrenaline can worsen device–patient physiology.
- Continue standard ALS diagnostics and correct reversible patient causes (tamponade, pneumothorax) promptly.
Inspect Circuit First, Treat Low Flow Rapidly
- ECMO team must fully expose the patient and methodically inspect tubing, cannulae, flow sensors, gas lines, and oxygenator connections.
- For low flow, reduce pump RPMs, give a fluid bolus (≈250–500 mL), and look for suction, bleeding, hemolysis, or thrombosis.
