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VV Algorithm 2012

This document outlines an algorithm for managing venovenous extracorporeal life support (VV ECLS). It provides steps based on measurements of SvO2 and SpO2. If SvO2 is low (<75) or SpO2 is low (<90), the first step is to assess values and potentially increase ECMO flow. If SvO2 is high (>85), decrease ECMO flow. If SpO2 is high (>98) or unable to safely increase flow, consider other causes and interventions like repositioning the patient or cannula. The algorithm then provides further steps to assess cardiac output, volume status, need for inotropes or transfusion based on those values and hematocrit

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38 views1 page

VV Algorithm 2012

This document outlines an algorithm for managing venovenous extracorporeal life support (VV ECLS). It provides steps based on measurements of SvO2 and SpO2. If SvO2 is low (<75) or SpO2 is low (<90), the first step is to assess values and potentially increase ECMO flow. If SvO2 is high (>85), decrease ECMO flow. If SpO2 is high (>98) or unable to safely increase flow, consider other causes and interventions like repositioning the patient or cannula. The algorithm then provides further steps to assess cardiac output, volume status, need for inotropes or transfusion based on those values and hematocrit

Uploaded by

api-302708069
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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VV ECLS ALGORITHM

SvO2 < 75
SpO2 < 90

ASSESS SvO2 & SpO2


SvO2 75-85
SpO 2 85-95

Increase ECMO flow

SvO2 > 85

Decrease ECMO flow

SpO2 >98

Unable to
Increase flow
Exclude :

low
Reposition patient
Raise bed (roller)

Assess CO
Reposition patient
Reposition cannula

ASSESS CO

Venous cannula obstruction / kink


Pain / anxiety / increased consumption

SpO2 < 85

high

Assess volume status

normal
fluid overload diurese
pain / anxiety.analgesia/sedation
idiopathic
vasodilator

normal / high

low
INOTROPE
? HYPOVOLEMIA
BP/CVP
Pulse pressure
Perfusion
Urine output
Tachycardia

ASSESS HAEMATOCRIT
yes

< 25 %

> 25 %

no
Transfuse
Packed rbcs

no action required
OR volume if hypovolemic
- platelets
- fresh frozen plasma
- albumin
- crystalloid

IF EUVOLEMIC
? TAMPONADE / TENSION PNEUMO- or HAEMOTHORAX
-High SvO2 (recirculation) / low PaO2
-Falling circuit flow
-signs of low CO ( small pulse pressure, poor perfusion, tachycardia)
? VENOUS CANNULA OBSTRUCTION
-Freq cut-out (roller)
-High negative access P (Biomedicus)
-High BP

VV ECLS MANAGEMENT ALGORITHM


SvO2 = measured mixed venous oxygen sat in circuit : Always some recirculation, so reads higher than true
SpO2 = patient peripheral oxygen saturatio

Policy #

BCCH Child & Youth Health Policy and Procedure Manual

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