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ECMO Circuit Haemolysis — FRCA Final MCQ

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HardIntensive Care MedicineECMO Circuit HaemolysisFRCA Final

A patient on ECMO develops significant haemolysis with free haemoglobin levels rising. What is the most likely cause?

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Correct answer: AThrombosis within the ECMO circuit/oxygenator

Rising free haemoglobin on ECMO most commonly indicates thrombosis within the circuit or oxygenator causing mechanical haemolysis (shear stress on red cells passing through fibrin deposits). Monitor plasma-free Hb, check circuit for clot, consider circuit/oxygenator change. Other causes: pump head thrombosis, cannula malposition causing turbulence.

Reference: ELSO – 2024 – ECMO management guidelines