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ECMO should be used to maintain a patient’s normal physiology if the patient does not have RIP. There may be an urgency, but the patient is in the lane and does not require resuscitation CPR. Normothermia can be used as well as a blood prime to maintain high oxygen delivery and normal iCa levels to maintain cardiac contractility.

ECPR patients are not in the lane and are often undergoing resuscitation CPR (that is, they have RIP). The extracorporeal strategy needed for dealing with RIP can be termed the three “C” strategy; cooling the patient, clear priming the pump to hemodilute the patient and using a calcium free perfusate. It can also be called the three “H” strategy; hypothermic hemodilution with hypocalcemia. The use of dantrolene should also be considered because it has significant protective effects against calcium stress.

Using a reperfusion strategy in an ECMO patient without RIP would unnecessarily expose that patient to hypothermia, hemodilution and hypocalcemia which could have iatrogenic sequelae.

Perfusion Theory is an educational platform for the Oxygen Pressure Field Theory (OPFT). August Krogh’s theoretical concept of the oxygen pressure field is explained and then applied to clinical applications in perfusion practice.