Extracorporeal membrane oxygenation (ECMO) has a few basic parts: an inflow (“drainage”) cannula, mechanical blood pump, membrane oxygenator, heat exchanger, and an outflow (“return”) cannula. In a motor failure, pump flow can be maintained via a hand crank while troubleshooting the problem.
To do this, the patient is emergently taken off ECMO by clamping the inflow and outflow cannulas. Since the patient is on ECMO for a reason (and you transiently interrupted it), the operator must provide full ventilation and hemodynamic support (pressors, inotropes) in the interim. Next, the pump head is moved to the emergency drive unit (pictured). The cannulas are unclamped. The operator begins hand-cranking while monitoring the ECMO pump speed, flow, and overall hemodynamics.
Although I’ve never actually seen this utilized in person, this crank is a backup option for both ECMO and cardiopulmonary bypass (CPB).
Please drop me a comment below with questions!
I was wondering if you could explain what would be done in an Intensive Care setting where there is no power, and not enough staff to help care for patients, Im sure there would be a perfusionist but has it ever been noted of a family member or simply a hospital orderly using the hand crank to keep a patient alive with ECMO?
Fortunately, I’ve not encountered this situation in the ICU, but I’d imagine if I ever did and we were stretched from a resources standpoint, we’d consider all possibilities.