Standards of Safety Management during Extracorporeal membrane oxygenation
(from The Japanese Society of Extra-corporeal Technology in Medicine)
[Standards of the equipment]
- A battery-drive system.
- A manual operation system with a hand crank.
- An oxygen blender.
- Alarm system for low and high blood flow for a centrifugal pump.
- An oxygen tank carrier for transportation is recommended.
- A bubble detector is recommended.
- Ability to measure the circuit pressures is recommended.
- Use a specially-made carrier for ECMO machine is recommended.
[Standards of the operation]
- Prepare a manual of ECMO operation and follow the manual when ECMO is used.
- Prepare safety checklists for the induction and operation of ECMO, separately.
- Perform a periodic inspection based on the instruction manual and keep inspection records.
[Standards during standby mode]
- Check the residual quantity of oxygen tank regularly, if an oxygen tank is equipped.
- Check the expiration dates of consumables and have a good stock of the consumables.
- Change the built-in battery regularly, and always keep the battery full.
[Standards during the induction of ECMO]
- Confirm no residual air in the circuit and clamp the priming lines.
- Check the flow of sweep gas.
- Check the blood flow
- Check the red color of return blood suggesting adequate oxygenation.
[Standards during transportation]
- Set the alarms adequately before transportation.
- Check the residual quantity of battery.
- Check the residual quantity of oxygen tank, taking the duration of transportation into account.
- Bring a hand crank for a possible manual operation.
- Check the flow of sweep gas and color of return blood during the exchange of gas sources.
- Pay attention to the kink, accidental extraction of the cannulas and the falling down of the machine.
[Standards during the operation]
- Confirm the power supply.
- Check the setting of alarms.
- A hand crank for the manual operation should be always available at the treatment room.
- Monitor the circuit, the machine and condition of the patient continuously.
- Check the oxygenation and anticoagulation state, regularly.
- Search for complications like bleeding around the cannulation site and limb ischemia.
- Connecting fluid lines or renal replacement circuit to the ECMO circuit is not recommended.
[Standards during the weaning]
- Adjust the ventilator setting, hemodynamic support, anticoagulation state and the dose of oxygen according to ECMO flow.
- Confirm the clamping of the circuit when ECMO support was stopped.
- Prepare to re-start ECMO support even after weaning.