PulmPEEPs

32. VV-ECMO Roundtable

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Jan 3, 2023
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INSIGHT

Basics of VV-ECMO Physiology

  • VV-ECMO drains blood from and returns oxygenated blood to central veins, relying on a functional heart for systemic circulation.
  • Oxygenation depends on blood flow, while CO2 removal is controlled by sweep gas flow rate through the membrane lung.
INSIGHT

VVECMO Patient Indications

  • Majority of VVECMO patients have acute respiratory distress syndrome (ARDS) or severe reversible respiratory failure.
  • Other uses include status asthmaticus, hypercapnic respiratory failure, and bridging to lung transplant.
ADVICE

Managing Oxygenation and CO2

  • Optimize oxygenation by adjusting ECMO blood flow and FiO2; CO2 removal by adjusting sweep gas flow rate.
  • For hypercapnic patients, start with lower sweep flow to prevent neurologic injury due to rapid CO2 removal.
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