⚠SpO₂ falling — ECMO circuit alarm. Assess the circuit and patient immediately.
SpO₂
71%
HR
124bpm
MAP
62mmHg
Temp
37.0°C
ECMO Circuit
Blood flow (Qb)4.5 L/min
Gas flow (sweep)6 L/min
FiO₂ blender1.0
Pre-oxygenator SaO₂65%
Post-oxygenator SaO₂91%
Trans-membrane ΔP60 mmHg
Ventilator (lung rest)
ModePC-AC
FiO₂ (vent)0.6
PC above PEEP10 cmH₂O
PEEP12 cmH₂O
RR (set)14/min
Vt (measured)285 mL
ABG (arterial)
pH
7.28
PaO₂
38 mmHg
PaCO₂
52 mmHg
HCO₃⁻
23 mEq/L
Lactate
3.4 mmol/L
Hgb
9.8 g/dL
Patient Context
Patient38F, 65 kg
DiagnosisH1N1 ARDS
ECMO dayDay 8
CannulaFem-Fem bilateral venous
VasopressorsNE 0.03 µg/kg/min
SedationMidazolam + Fent
Clinical Decision Required — Case 2
SpO₂ has fallen from 88% to 71% over the last 3 hours. Yesterday the post-oxygenator SaO₂ was 99%. Today it is 78%. The oxygenator housing appears hazy and darkened. Transmembrane pressure gradient is 60 mmHg (normal <30 mmHg). Sweep gas is connected and blender reads FiO₂ 1.0. What do you do?