2025 Pulmonary and Critical Care Medicine Fellows Course (INVITE ONLY)-ECMO Handout

ECMO Handout

Pdf Summary

This VV ECMO handout outlines key aspects of venovenous extracorporeal membrane oxygenation (VV ECMO), including indications, contraindications, configurations, and management of complications such as hypoxemia.

<strong>Indications</strong> for VV ECMO include severe acute respiratory distress syndrome (ARDS), refractory hypoxemia despite maximal mechanical ventilation, refractory hypercapnia, and use as a bridge to lung transplantation. <strong>Contraindications</strong> include bleeding disorders, irreversible brain injury, untreatable malignancies, and severe irreversible multiorgan failure.

Several <strong>ECMO configurations</strong> are reviewed:
- Femoral-femoral VV ECMO offers easy and quick cannulation but limits patient ambulation.
- Dual-lumen VV ECMO allows simpler, faster cannulation and better patient mobilization but may offer limited flow rates.
- Protek Duo VV ECMO provides simultaneous VV and right ventricular assist device (RVAD) support but comes with increased technical complexity.
- Femoral-internal jugular VV ECMO provides adequate drainage but risks recirculation.

Management parameters include:
- <strong>Sweep gas flow rate</strong>, adjusted to optimize oxygenation and carbon dioxide removal.
- <strong>Fraction of inspired oxygen (FDO2)</strong>, manipulated to maintain target arterial oxygen saturation.
- <strong>ECMO flow rate</strong>, regulated to ensure adequate oxygen delivery and CO2 clearance.

Common causes of hypoxemia during VV ECMO are due to cannulation issues (recirculation, inadequate drainage, thrombus), patient factors (sepsis, vasodilation, hypovolemia, hypertension), or pump-related problems (pump thrombus, oxygenator failure).

For more detailed hypoxemia management strategies, a referenced article is provided: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935134/

Queries can be addressed to session leads Drs. Bindu Akkanti at McGovern Medical School and Navitha Ramesh at University of Pittsburgh Medical Center.

Keywords

VV ECMO

venovenous extracorporeal membrane oxygenation

ARDS

hypoxemia

ECMO configurations

femoral-femoral cannulation

dual-lumen cannulation

Protek Duo

sweep gas flow rate

ECMO complications