chattering in ecmo circuit from vessel collapse

Chattering, or chugging, describes highly variable flow rates and rhythmic pulsations of the ECMO tubing. The pump creates a negative pressure in the large vein through which venous blood is drawn into the ECMO circuit.

Chattering occurs when the negative pressure in the venous system causes the vessel to collapse, temporarily interrupting blood flow.

Common causes of chattering include high pump speed (rpms), malpositioned cannulas, extrinsic kinking or compression of the drainage limb of the ECMO circuit, increased inspiratory effort, coughing, and volume depletion.

Remedies include decreasing the pump speed (rpms) and ECMO circuit blood flow, correcting cannula positioning or kinking, increasing the sweep gas flow to reduce patient inspiratory effort, or volume resuscitating the patient.1234

Footnotes

  1. SEEK Questionnaires ↩

  2. Patel B, Arcaro M, Chatterjee S. Bedside troubleshooting during venovenous extracorporeal membrane oxygenation (ECMO). J Thorac Dis. 2019;11(suppl 14):S1698-S1707. PubMed ↩

  3. Staudacher DL, Bode C, Wengenmayer T. Fluid therapy remains an important cornerstone in the prevention of progressive chugging in extracorporeal membrane oxygenation. Heart Lung. 2018;47(4):432. PubMed ↩

  4. Walter JM, Kurihara C, Corbridge TC, et al. Chugging in patients on veno-venous extracorporeal membrane oxygenation: an under-recognized driver of intravenous fluid administration in patients with acute respiratory distress syndrome? Heart Lung. 2018;47(4):398-400. PubMed ↩