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Standards of Safety Management during Extracorporeal membrane oxygenation

 (from The Japanese Society of Extra-corporeal Technology in Medicine)


 [Standards of the equipment]

  1. A battery-drive system.
  2. A manual operation system with a hand crank.
  3. An oxygen blender.
  4. Alarm system for low and high blood flow for a centrifugal pump.
  5. An oxygen tank carrier for transportation is recommended.
  6. A bubble detector is recommended.
  7. Ability to measure the circuit pressures is recommended.
  8. Use a specially-made carrier for ECMO machine is recommended.


 [Standards of the operation]

  1. Prepare a manual of ECMO operation and follow the manual when ECMO is used.
  2. Prepare safety checklists for the induction and operation of ECMO, separately.
  3. Perform a periodic inspection based on the instruction manual and keep inspection records.


[Standards during standby mode]

  1. Check the residual quantity of oxygen tank regularly, if an oxygen tank is equipped.
  2. Check the expiration dates of consumables and have a good stock of the consumables.
  3. Change the built-in battery regularly, and always keep the battery full.



[Standards during the induction of ECMO]

  1. Confirm no residual air in the circuit and clamp the priming lines.
  2. Check the flow of sweep gas.
  3. Check the blood flow
  4. Check the red color of return blood suggesting adequate oxygenation.



[Standards during transportation]

  1. Set the alarms adequately before transportation.
  2. Check the residual quantity of battery.
  3. Check the residual quantity of oxygen tank, taking the duration of transportation into account.
  4. Bring a hand crank for a possible manual operation.
  5. Check the flow of sweep gas and color of return blood during the exchange of gas sources.
  6. Pay attention to the kink, accidental extraction of the cannulas and the falling down of the machine.



[Standards during the operation]

  1. Confirm the power supply.
  2. Check the setting of alarms.
  3. A hand crank for the manual operation should be always available at the treatment room.
  4. Monitor the circuit, the machine and condition of the patient continuously.
  5. Check the oxygenation and anticoagulation state, regularly.
  6. Search for complications like bleeding around the cannulation site and limb ischemia.
  7. Connecting fluid lines or renal replacement circuit to the ECMO circuit is not recommended.



[Standards during the weaning]

  1. Adjust the ventilator setting, hemodynamic support, anticoagulation state and the dose of oxygen according to ECMO flow.
  2. Confirm the clamping of the circuit when ECMO support was stopped.
  3. Prepare to re-start ECMO support even after weaning.