ECMO Troubleshooting Guide

The insider troubleshooting framework senior perfusionists use — but rarely teach.

5 pages. Every major ECMO emergency. One reference you can pull up at 2am.

What's inside:

• Oxygenator failure — early recognition, plasma leak vs. water vapor, response algorithm
• Circuit emergencies — air entrainment, clot, and circuit chatter (step-by-step)
• Hemodynamic instability — VA and VV differential, LV distension, North-South syndrome
• Anticoagulation crisis — target parameters, major bleeding protocol, thrombosis response
• Decannulation decision framework — VV and VA wean criteria, pre-decannulation checklist

Written by Tom Ferry, CCP — perfusionist, ECMO specialist, and founder of Central Coast Perfusion LLC. Author of the ECMO Black Book.

For educational use. Not a substitute for institutional protocols or clinical judgment.