Cardiac Critical Care Advisor
Coagulation · ABG · Ventilation · Hemodynamics · ECMO
🔬
ROTEM
Sigma · KFAFH
📊
TEG
6s · 2025
🧪
ABG & Labs
Electrolytes
🫀
ECMO
VA · VV
🌡 Basic ROTEM
°C
g/dL
🔬 Fibrinolysis
%
🩸 Platelets & Fibrinogen
mm
mm
💉 Coagulation Factors
sec
💊 Heparin Effect
sec
sec
📷 AI Image Extraction
📸
Camera
🖼️
Upload
🌡 Basic TEG 6s
°C
g/dL
💊 Heparin Effect
min
min
🔬 Fibrinolysis
%
🩸 Fibrinogen & Platelets
mm
mm
min
°
📷 AI Image Extraction
📸
Camera
🖼️
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📷 Scan ABG / Monitor AI
🩸 ABG Printout
📸
Camera
🖼️
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🖥️ Patient Monitor
📸
Camera
🖼️
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🫁 Arterial Blood Gas ABG
mmHg
mEq/L
mEq/L
mmHg
%
⚡ Electrolytes LABS
mEq/L
mEq/L
mEq/L
mmol/L
mg/dL
g/L
🔥 Metabolic LABS
mg/dL
mmol/L
mOsm/kg
mg/dL
💓 Cardiac Output — Indirect Fick INTRAOP
CO = VO₂ ÷ C(a-v)O₂ — All values obtainable from ABG + Venous Gas + Anaesthetic Machine
VO₂ = MV × (FiO₂ − FeO₂) × 10 | CaO₂ = (1.34 × Hb × SaO₂) + (0.003 × PaO₂) | CvO₂ = (1.34 × Hb × SvO₂) + (0.003 × PvO₂)
🩸 Arterial Blood Gas
g/dL
%
mmHg
🔵 Mixed Venous Blood Gas
%
mmHg
🔧 Anaesthetic Machine / Ventilator
L/min
%
%
mmHg
🫁 Ventilation Management VENT
Assess need for MV, recommend settings, diagnose ARDS/ALI, track serial ABGs, guide weaning
📷 Scan Ventilator Screen
📸
Camera
🖼️
Upload
📋 Current Ventilation Status
/min
mL
%
mL
/min
/min
cmH₂O
%
cmH₂O
cmH₂O
cmH₂O
cmH₂O
📊 Clinical Context (for recommendation)
/15
📈 ABG Serial Tracking
No ABGs saved yet. Analyze then save to track trends.
1Assessment
2Setup
3Monitor
4Trend
5Weaning
🚨Emergency
📋 ECMO Candidacy Assessment
Enter patient data to determine ECMO candidacy, recommended type, and urgency.
🏥 Patient & Diagnosis
KG
CM
YRS
💓 Hemodynamics
mmHg
bpm
mmHg
mmol/L
%
%
💊 Current Support
mcg/kg/min
mcg/kg/min
🫁 Respiratory
mmHg
%
mmHg
cmH₂O
cmH₂O
🚫 Contraindications Check
⚠️ Complete Phase 1 (Assessment) first to generate ECMO configuration.
📊 ECMO Monitoring — Periodic Data Entry
Enter current values. Leave blank any not available. VA-ECMO
📷 ECMO Console
📸
Camera
🖼️
Upload
📷 Bedside Monitor
📸
Camera
🖼️
Upload
🔧 Circuit Data
L/min
%
L/min
💓 Vitals
mmHg
bpm
mmHg
%
%
°C
mL/hr
🧪 ABG
mmHg
mmHg
mEq/L
mmol/L
💉 Anticoagulation
IU/mL
sec
sec
U/kg/h
🩸 Blood Panel
g/dL
×10³
mg/dL
🔬 Hemolysis Markers
g/dL
U/L
mg/L
🫀 Echocardiography (VA-ECMO)
%
cm
cm
cm
🫁 Native Lung Assessment (VV-ECMO)
%
mL/cmH₂O
📈 Patient Trend — Monitoring History
No monitoring entries yet. Go to Monitor phase to add data.
🔄 Weaning Readiness Assessment
Based on latest monitoring data + clinical assessment
Complete at least one monitoring entry first.
🚨 ECMO Emergency — FIRST 30 SECONDS UNIVERSAL
⚡
Universal Emergency Protocol
1. CALL FOR HELP — ECMO specialist, perfusionist, surgeon
2. CLAMP both lines if circuit compromised
3. Pre-ECMO vent settings — FiO₂ 100%
4. VA: CPR if pulseless / VV: Bag 100% O₂
5. Prepare emergency circuit
6. Defibrillator pads on patient
2. CLAMP both lines if circuit compromised
3. Pre-ECMO vent settings — FiO₂ 100%
4. VA: CPR if pulseless / VV: Bag 100% O₂
5. Prepare emergency circuit
6. Defibrillator pads on patient
💨 Air Embolism CATASTROPHIC
CLAMP return → STOP pump → Trendelenburg + left lateral → ventilate 100% → de-air circuit (aspirate from vent port) → identify source → circuit change if unstable
🔴 Circuit Thrombosis URGENT
Check Anti-Xa/ACT → heparin bolus 5000 IU → small clots: monitor + ↑anticoag → large clots/impaired gas exchange → circuit change → post-change ABG in 15min
⚡ Power/Pump Failure CATASTROPHIC
CLAMP both → VA: CPR / VV: ventilate → hand-crank pump > 1 L/min → backup battery → pump failure = emergency circuit change → heparin 5000 IU
🩸 Cannula Displacement CATASTROPHIC
Drainage out: Air entry → CLAMP + STOP → direct pressure → CPR/ventilate → re-cannulation
Return out: Massive hemorrhage → CLAMP return → HARD pressure → MTP → surgical repair
Return out: Massive hemorrhage → CLAMP return → HARD pressure → MTP → surgical repair
📉 Low Flow / Chatter URGENT
8-cause check: 1) Hypovolemia → fluid 2) Malposition → echo 3) Kink → check tubing 4) Pneumothorax/Tamponade 5) Abdominal compartment 6) Excessive RPM 7) Venous suck-down 8) Circuit thrombus
🫁 Harlequin Syndrome VA ONLY
Right hand SpO₂ < foot SpO₂ (>10% diff) → ↑Vent FiO₂ 100% → ↑ECMO flow → consider IJV return cannula → convert VAV-ECMO
🩸 Major Bleeding COMMON 30%
↓Heparin (Anti-Xa 0.2-0.3) → life-threatening: STOP heparin → Plt > 80K, Fib > 200, FFP if INR>1.5, Hb > 8 → TXA 1g if fibrinolysis → ⚠️ NEVER factor VIIa → ROTEM/TEG guided
🦵 Limb Ischemia VA FEMORAL
DPC at cannulation (6-8 Fr) → check pedal pulses q4h + NIRS → ischemia signs → insert/reposition DPC → fasciotomy if compartment > 30 mmHg → consider axillary switch
🔴 Hemolysis MONITOR
pfHb q12-24h: <0.05 normal, 0.05-0.10 investigate, >0.10 action, >0.50 urgent → ↓RPM → check access insufficiency → inspect pump head → upsize cannula → monitor renal
Clinical Decision Support — Not a Substitute
Always correlate clinically.
Developed by
Dr Ahmed Elsonbaty
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Cardiac Critical Care Advisor Pro v6.0