Evaluation of the Nautilus Smart Extracorporeal Membrane Oxygenation in Patients With Hemostatic Alteration: A Case Series

The intricate management of hemostatic disorders in extracorporeal membrane oxygenation (ECMO) assisted patients poses challenges, particularly when procoagulant administration is necessary. We hereby report the performance of the Nautilus* Smart ECMO Module in three patients with hemostatic disorders. We collected data from ECMO procedures with Nautilus* Smart ECMO Module and analyzed the performance: the operating pressures and resistance of the device in addition to the coagulation status of the patients. During the three procedures, partial pressure oxygen post-oxygenator (paO 2 ) stayed above 100 mm Hg and partial pressure carbon dioxide post-oxygenator (paCO 2 ) did not exceed 45 mm Hg. Membrane FiO 2 (fractional inspired O 2 ) did not exceed 75% and air flow remained within a 1:1 ratio with blood flow in veno-arterial ECMO (V-A) and within 1:2 in veno-venous ECMO (V-V). There was no evidence of excessive operating pressure for the device, with a pressure drop consistently below 28 mm Hg and a maximum peak resistance of 7 Δmm Hg/L/min. The Nautilus* Smart ECMO Module showed good performance in patients with hemostatic disorders despite the implications associated with procoagulant administration.