Program Code: SCF-DBI-PCICU-ECMO-0001**
Operational Window: ECMO Candidate Identification → Cannulation → Stabilization → Recovery → Decannulation → Long-Term Follow-Up
Primary Objective: Preserve biologic intelligence during severe cardiovascular collapse, maintain cerebral viability, support myocardial recovery, prevent secondary injury, and optimize long-term recovery outcomes.
SECTION 8.1
CLINICAL POSITIONING
Traditional ECMO Model
ECMO is traditionally viewed as:
Mechanical cardiopulmonary support
used when conventional therapy fails.
SCF-DBI ECMO Model
ECMO is viewed as:
Biological Intelligence Preservation Technology
designed to:
Preserve cerebral adaptation
Preserve myocardial recovery potential
Preserve endothelial integrity
Preserve immune competence
Preserve recovery intelligence
Core Principle
The purpose of ECMO is not simply survival.
The purpose is preservation of recoverable biology.
SECTION 8.2
ECMO ACTIVATION CRITERIA
Primary Indications
Refractory cardiogenic shock
Fulminant myocarditis
Severe postoperative cardiac failure
Primary graft dysfunction
ECPR candidates
Mechanical circulatory collapse
Refractory low cardiac output syndrome
Secondary Indications
Bridge-to-recovery
Bridge-to-decision
Bridge-to-transplant
Bridge-to-VAD
SECTION 8.3
ECMO BIOLOGICAL INTELLIGENCE STAGING
Stage I
Threatened Adaptation
Characteristics:
Progressive hemodynamic instability
Increasing vasoactive support
NCRS decline
Stage II
Severe Adaptation Failure
Characteristics:
Cardiogenic shock
Tissue hypoperfusion
Rising lactate
Stage III
Impending Collapse
Characteristics:
Progressive organ dysfunction
Severe oxygen debt
ANMS decline
Stage IV
Biologic Intelligence Collapse
Characteristics:
Cardiac arrest
Severe circulatory failure
Rescue activation
SECTION 8.4
ECPR (EXTRACORPOREAL CPR) PROGRAM
Clinical Positioning
ECPR is viewed as:
Cerebral Recovery Preservation Strategy
for selected cardiac arrest patients.
Candidate Characteristics
Witnessed arrest
High-quality CPR
Reversible etiology
Preserved recovery potential
Strategic Goals
Restore oxygen delivery
Preserve cerebral viability
Preserve myocardial recovery
Minimize ischemic burden
Immediate Monitoring
Lactate
NIRS
Cerebral oxygenation
ANMS
CAI
SECTION 8.5
VA-ECMO MANAGEMENT FRAMEWORK
Strategic Objective
Provide circulatory support while promoting myocardial recovery.
Primary Targets
Oxygen delivery
Organ perfusion
Cerebral perfusion
Myocardial unloading
Core Monitoring
ECMO flow
Cardiac output
Lactate
Mixed venous oxygen saturation
Echocardiography
SCF Monitoring
ANMS
NCRS
EII
CAI
STRI
SECTION 8.6
ECMO NEUROLOGIC PROTECTION PLATFORM
Clinical Positioning
Neurologic injury represents the highest long-term risk during ECMO.
Protection Objectives
Maintain cerebral oxygenation
Maintain cerebral perfusion
Minimize secondary injury
Preserve neurodevelopment
Surveillance Components
Neurologic Examination
Continuous EEG
Cerebral NIRS
Neuroimaging
CAI Monitoring
SECTION 8.7
ENDOTHELIAL PRESERVATION DURING EXTRACORPOREAL SUPPORT
Strategic Position
Extracorporeal circulation produces endothelial stress.
Core Threats
Glycocalyx injury
Inflammatory activation
Microvascular dysfunction
Perfusion heterogeneity
Monitoring Variables
EII
Lactate
Tissue oxygenation
Organ perfusion
Recovery Objectives
Preserve endothelial adaptation
Prevent organ injury
SECTION 8.8
ECMO IMMUNOLOGIC SURVEILLANCE PROGRAM
Purpose
Identify immune dysregulation and infection risk.
Monitoring Domains
Inflammation
Infection burden
Recovery progression
Self-tolerance preservation
Core Variables
CRP
Procalcitonin
Ferritin
STRI
ANMS
SECTION 8.9
RHENOVA ECMO RECOVERY ARCHITECTURE
Strategic Objective
Initiate recovery immediately after ECMO stabilization.
Recovery Domain 1
Myocardial Recovery
Recovery Domain 2
Neurologic Recovery
Recovery Domain 3
Endothelial Recovery
Recovery Domain 4
Immune Recovery
Recovery Domain 5
Functional Recovery
Recovery Domain 6
Family Recovery
SECTION 8.10
ECMO DAILY MULTIDISCIPLINARY REVIEW
Required Participants
Cardiac Intensivist
ECMO Specialist
Cardiothoracic Surgery
Neurology
Rehabilitation
Pharmacy
Nutrition
Nursing Leadership
Daily Review Domains
Cardiac recovery
Neurologic recovery
Perfusion status
Recovery readiness
Decannulation readiness
SECTION 8.11
ECMO COMPLICATION SURVEILLANCE FRAMEWORK
Neurologic Complications
Stroke
Hemorrhage
Seizures
Encephalopathy
Cardiovascular Complications
Ventricular distension
Arrhythmias
Persistent dysfunction
Hematologic Complications
Bleeding
Thrombosis
Coagulopathy
Infectious Complications
Bloodstream infection
Cannula infection
Device-related infection
SECTION 8.12
ECMO WEANING READINESS FRAMEWORK
Cardiac Readiness
Improved ventricular function
Improved cardiac output
Reduced vasoactive support
Perfusion Readiness
Lactate normalization
Stable organ function
Adequate oxygen delivery
SCF Readiness
Improving ANMS
Improving NCRS
Improving EII
Improving CAI
SECTION 8.13
DECANNULATION SOP
Decannulation Criteria
Stable hemodynamics
Sufficient myocardial recovery
Stable oxygen delivery
Positive recovery trajectory
Immediate Post-Decannulation Monitoring
Echocardiography
Lactate
NIRS
ANMS
NCRS
SECTION 8.14
ECMO RECOVERY INTELLIGENCE PROGRAM
Post-ECMO Recovery Domains
Cardiac function
Neurologic function
Functional recovery
Growth recovery
Educational recovery
Monitoring Timeline
ICU discharge
↓
30 days
↓
90 days
↓
6 months
↓
12 months
SECTION 8.15
ECMO SUCCESS ENDPOINTS
Clinical
Survival to decannulation
Survival to discharge
Reduced organ injury
Functional
Preserved neurodevelopment
Preserved mobility
Preserved educational participation
Biological Intelligence
ANMS >80
NCRS >80
EII >80
CAI >80
STRI >80
Sustained recovery trajectory
PAGE 8 COMPLETION
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