⚠SpO₂ persistently low — circuit functioning. Assess the patient.
SpO₂
78%
HR
112bpm
MAP
70mmHg
Temp
37.4°C
ECMO Circuit
Blood flow (Qb)2.5 L/min
Gas flow (sweep)6 L/min
FiO₂ blender1.0
Pre-oxygenator SaO₂68%
Post-oxygenator SaO₂99%
Trans-membrane ΔP15 mmHg
Ventilator (lung rest)
ModePC-AC
FiO₂ (vent)0.5
PC above PEEP10 cmH₂O
PEEP12 cmH₂O
RR (set)12/min
Vt (measured)300 mL
ABG (arterial)
pH
7.30
PaO₂
44 mmHg
PaCO₂
46 mmHg
HCO₃⁻
22 mEq/L
Lactate
2.9 mmol/L
Hgb
8.5 g/dL
Patient Context
Patient60M, 85 kg
DiagnosisPost-op ARDS
ECMO dayDay 6
CannulaFem-Fem bilateral venous
VasopressorsNE 0.03 µg/kg/min
Clinical Decision Required — Case 3
The circuit is fully functional — oxygenator post-SaO₂ is 99% with no circuit alarms. The transmembrane pressure is low. However SpO₂ remains 78% and lactate is rising. What is the most appropriate IMMEDIATE next step?