A new study published in Critical Care has shed light on an important aspect of Extracorporeal Membrane Oxygenation (ECMO) management that could significantly improve patient outcomes: blood cell salvage during decannulation. This research provides compelling evidence for a practice that could reduce transfusion requirements and their associated risks, marking another step forward in optimizing ECMO care.

Understanding the Challenge of Decannulation

When a patient has recovered from their underlying illness and is ready to be removed from ECMO support, the process of removing the cannulas—known as decannulation—presents unique challenges. The ECMO circuit itself contains approximately 500-700ml of extended patient blood volume, which is traditionally discarded. This blood, combined with any blood lost during the decannulation procedure, may necessitate blood transfusions to maintain adequate hemoglobin levels.

 

While blood transfusions are sometimes necessary, they’re not without risks. Patients may experience complications ranging from allergic reactions to more serious issues like transfusion-related acute lung injury or immunological complications. Additionally, blood products are a precious resource that should be conserved whenever possible.

The Promise of Blood Cell Salvage

This is where blood cell salvage (BCS) systems come into play. These sophisticated systems collect blood from the ECMO circuit during decannulation, process it through high-speed centrifugation, and prepare it for reinfusion to the patient. The result? The patient receives their own blood cells back, maintaining their hemoglobin levels more effectively and reducing the need for donor blood products.

The new research, conducted across two major ECMO centers in the UK, provides compelling evidence for the benefits of this approach. The study found that using BCS during decannulation resulted in the following:

• A significant reduction in packed red blood cell transfusions
• Better maintenance of hemoglobin levels post-decannulation
• No negative impact on inflammatory markers or coagulation
• A dramatic reduction in transfusion needs, cutting the percentage of patients receiving blood transfusions in half from 34.6% to 17.5%

Implications for ECMO Programs

The findings from this study have significant implications for ECMO programs worldwide. The ability to reduce transfusion requirements doesn’t just benefit individual patients—it represents a meaningful advancement in ECMO care that can improve outcomes, conserve valuable blood products, and potentially reduce healthcare costs.

Creating and maintaining a successful ECMO program requires constant evolution based on emerging evidence. This is where having the right partner becomes crucial. At Innovative ECMO Concepts, we understand that staying current with research isn’t just about knowing what’s new—it’s about understanding how to effectively implement existing technology and advances into daily practice.

Our approach to program development goes beyond just sharing information. We help programs translate research findings like these into practical, implementable protocols. This includes:

• Developing comprehensive policies and procedures that incorporate evidence-based practices
• Creating standardized guidelines for processes like blood conservation during decannulation
• Training teams on new techniques and equipment
• Ensuring quality metrics are in place to track outcomes

Whether you’re establishing a new ECMO program or enhancing an existing one, we’re here to help you navigate these advances and implement them in ways that make sense for your intuition’s specific situation.