⚠Acute SpO₂ drop — no circuit flow alarms. Assess the circuit immediately.
SpO₂
70%
HR
130bpm
MAP
65mmHg
Temp
37.1°C
ECMO Circuit
Blood flow (Qb)2.5 L/min
Gas flow (sweep)6 L/min
FiO₂ blender1.0
Pre-oxygenator SaO₂66%
Post-oxygenator SaO₂99%
Ventilator (lung rest)
ModePC-AC
FiO₂ (vent)0.5
PC above PEEP10 cmH₂O
PEEP12 cmH₂O
RR (set)12/min
Vt (measured)290 mL
ABG (arterial)
pH
7.36
PaO₂
36 mmHg
PaCO₂
36 mmHg
HCO₃⁻
26 mEq/L
Lactate
3.1 mmol/L
Hgb
10.2 g/dL
Patient Context
Patient44M, 72 kg
DiagnosisViral ARDS
ECMO dayDay 3
CannulaFem-Fem bilateral venous
VasopressorsNE 0.03 µg/kg/min
SedationPropofol + Fent
Clinical Decision Required — Case 4
SpO₂ has fallen from 96% to 70% acutely over 15 minutes. ECMO Blood flow is 2.5 L/min — down from 4 L/min. The blender reads FiO₂ 1.0 and sweep flow meter reads 6 L/min. The patient has ongoing bleeding after lung transplantation earlier today. The ECMO tubing is shaking and ‘chugging’. What has happened and what do you do first?