VV vs VA ECMO – How Do You Know?
This type of ECMO supports both heart and lung function.
What is VA ECMO?
In a VV ECMO patient, increasing lactate levels and falling SpO2, despite full flows may indicate this.
What is worsening lung injury or oxygenator failure?
You notice low circuit flow and a sudden drop in pre-membrane pressure. The pump is chattering. What’s the likely cause?
What is hypovolemia or cannula drainage insufficiency?
This neonatal lung condition is a common indication for VV or VA ECMO, especially in full-term infants with respiratory failure.
What is Persistent Pulmonary Hypertension of the Newborn (PPHN)?
A patient on VA ECMO shows signs of cardiac stunning and asystole. You want to prevent stasis and thrombus formation. What’s your next step?
What is start a LV vent or ensure pulsatility via pacing or inotropes?
This type of ECMO is used primarily for isolated respiratory failure.
What is VV ECMO?
A VA ECMO patient becomes hypertensive with narrow pulse pressure. What change in cardiac function is likely?
What is decreased LV ejection (poor pulsatility)?
The post-oxygenator pressure is high, and the delta pressure across the oxygenator has increased. What’s the most likely issue?
What is oxygenator clotting or failure?
In congenital diaphragmatic hernia (CDH), ECMO is often used when this happens despite maximal medical therapy.
What is refractory hypoxemia or pulmonary hypertension crisis?
A VV ECMO patient develops signs of DIC - ”oozing from lines, prolonged PT/aPTT, low fibrinogen. What’s your first clinical priority?
What is stop anticoagulation and correct coagulopathy with blood products?
On chest X-ray, this cannula tip location suggests VV ECMO with a dual-lumen catheter.
What is the right atrium (or cavoatrial junction)?
This hemodynamic pattern in VA ECMO suggests recovery: increasing pulse pressure and reduced ECMO flow needs.
What is improved native cardiac function?
There’s high pre-membrane pressure but normal post-membrane pressure. The pump flow is stable. What complication is likely?
What is a clot in the drainage limb or cannula?
This method can assess cardiac recovery during VA ECMO weaning in a child post-cardiotomy.
What is echocardiography with clamp trial or flow wean assessment?
The oxygenator shows signs of failure: increased delta pressure, low post-membrane PaO2, and rising lactate. What’s your intervention?
What is perform an urgent oxygenator exchange?
This hemodynamic monitoring change suggests poor LV unloading in VA ECMO.
What is increased pulmonary capillary wedge pressure or pulsatility loss?
In a VV ECMO patient, sudden tachycardia, hypotension, and high CVP may indicate this complication.
What is tension pneumothorax or massive PE?
The pump flow suddenly drops and the RPMs increase. You inspect and find a large kink in the drainage tubing. What is the underlying problem?
What is increased resistance causing negative pressure (suction event)?
In a neonate on ECMO with bleeding, thrombocytopenia, and fibrinogen <100 mg/dL, you should manage this way.
What is transfuse platelets, cryoprecipitate, and hold anticoagulation?
During high RPMs, you observe hemolysis and reddish urine. Plasma-free hemoglobin is elevated. What circuit issue might this be, and what’s your response?
What is pump head thrombosis; replace the pump and assess circuit integrity?
This physical exam finding may indicate North / South syndrome (Harlequin Syndrome) during femoral VA ECMO.
What is upper body cyanosis with pink lower extremities?
A VA ECMO patient has rising lactate, low mean arterial pressure (MAP), and decreasing mixed venous oxygen saturation (SvOâ‚‚). What is the likely underlying issue?
What is systemic hypoperfusion due to worsening cardiac function or high afterload?
There’s high pre-membrane and post-membrane pressure, poor flows, and hemolysis. What’s happening in the ECMO circuit?
What is thrombus formation in both limbs or the oxygenator (diffuse clotting)?
This score or tool is used to predict survival in pediatric ECMO patients.
What is the P-PREP score (Pediatric-PREdiction of ECMO survival)?
A child on ECMO has multisystem organ failure with no evidence of neurologic recovery and no weaning potential. What is the next appropriate step in care planning?
What is initiate ethics/family meeting to discuss goals of care and consider withdrawal?