⚠SpO₂ critically low — patient on VV-ECMO. Assess the circuit and patient immediately.
SpO₂
74%
HR
118bpm
MAP
68mmHg
Temp
37.2°C
ECMO Circuit
Blood flow (Qb)4.2 L/min
Gas flow (sweep)6 L/min
FiO₂ blender1.0
Pre-oxygenator SaO₂85%
Post-oxygenator SaO₂99%
Trans-membrane ΔP20 mmHg
Ventilator (lung rest)
ModePC-AC
FiO₂ (vent)0.5
PC above PEEP10 cmH₂O
PEEP12 cmH₂O
RR (set)12/min
Vt (measured)310 mL
ABG (arterial)
pH
7.31
PaO₂
42 mmHg
PaCO₂
44 mmHg
HCO₃⁻
22 mEq/L
Lactate
2.8 mmol/L
Hgb
9.2 g/dL
Patient Context
Patient52M, 78 kg
DiagnosisSevere ARDS
ECMO dayDay 4
CannulaFem-Fem bilateral venous
VasopressorsNE 0.03 µg/kg/min
SedationPropofol + Fent
Clinical Decision Required — Case 1
The nurse flags SpO₂ 74% — down from 95% over the last hour, since the patient returned from the CT scanner. ECMO blood flow was increased from 3.7 to 4.2 L/min, with no improvement in SpO₂. Pre-membrane SaO₂ is 85% (it used to be 62%), post-membrane 99%. There are flashes of bright red blood in the drainage cannula, similar in color to the return cannula. What is the MOST appropriate solution to this issue?