Extracorporeal Membrane Oxygenation
(ECMO)
by Jared Bienstock, MS, CCP, LP, CES-A
Copyright © 2021 (All Rights Reserved)

2 Main Types of ECMO

Veno-Arterial
(VA)

Vent Management

VA Vent Settings
TV= 6-9 ml/kg IBW
RR= 6-12 B/min
PEEP=10-15cmH2O
FiO2>50%

*Little literature exists
on optimal vent
management for VA
ECMO

ECMO Management

ECMO Ranges
FiO2=100%
Sweep= 1:1 w/Q
SaO2 = 97-100%
PaO2 >200mmHg
Flow= 60ml/kg/min
PCWP <20 mmHg
PP= 10-15 mmHg

Cannulation

Initiation

Weaning

Weaning VA ECMO

Strategy Recommendation 1:
-Optimize: Vent settings, vascular fluid balance, cardiac drugs, support devices (IABP/Impella), slowly reduce blood flow to minimum
-Consider raising ACT if ECMO blood flow is low (<2 LPM)

Strategy Recommendation 2
-ECMO flows are dropped
-A successful weaning means no significant deterioration in the hemodynamic variables and improvement in cardiac function should be seen by echocardiography
-Values of successful wean: 1) Aortic VTI (>10cm), 2) TDSa mitral annulus (>6cms-1), 3)LVEF (>20-25%)

*Do NOT turn off the sweep while weaning

Complications

1. Differential Hypoxia, north-south syndrome, mixing cloud, aka harlequin syndrome (all the same)
2. Pseudo-differential hypoxia and Reverse-differential hypoxia

Cardiac Arrest

Anticoagulation

Equipment

Such as (but not limited to...)
-ECMO circuit
-Heparin
-Saline/Plasmalyte
-Pressure infusion bag
-Pressure Transducer Set Double set
-Backup O2 Cylinder
-Backup console
-Cable ties to all connections
-Clamps medium x 4
-Oxygen Tubing
-Sterile tubing scissors
-Emergency Hand crank x
-ACT machine
-Heater-cooler
-Record keeping

Machines:
1. Centrimag - Abbott
2. Bioconsole - Medtrnoic
3. Rotaflow - Getinge
4. SCPC - Livanova
5. Cardiohelp -Getinge

Preparation

Have available:
-Primed Circuit
-Gas Source
-Cannulas (proper sizes)
-Heparin/Other Drugs
-Ultrasound
-Clamps
-Sterile Scissors
-Pik-A/V
-Venous dilator kit

Personnel

Key members:
-Surgeon
-Intensivist
-Perfusionist
-Physician Assistant
-Nurse/Nurse Practitioner
-Respiratory Therapist
-ECMO Specialist

Checklist

Sample:
-Console connected to AC
-Hand crank available
-Spare O2 tank available
-Pressure lines flushed
-Inspect oxygenator for clots
-Clamps available
-Lines are not kinked

Medication

Sedation, Analgesia
and Paralytics

Catastrophes

Complications:
-Cannula dislodgment
-Air entrainment

Veno-Veno
(VV)

Vent Management

VV Vent Settings
PIP< 30cmH2O
PPlat<30cmH2O
TV<6 ml/KG IBW
RR = 4-6 B/Min
PEEP =10-15 cmH2O
FiO2 <40%(0.40)

ECMO Management

VV ECMO Ranges
FiO2= 100%
Sweep= 1:1 w/ Q
SaO2 = >80% tolerable
PaO2=55-90mmHg
Flow= 2/3 of CO
50-80 ml/kg/min
PP= Nl 40mmHg

Cannulation

Initiation

Weaning

Weaning VV ECMO

Strategy Recommendation 1:
-Increase ventilator to appropriate settings
-Reduce FiO2 on ECMO blender
-Reduce ECMO sweep flow rate

Strategy Recommendation 2:
-Progressively decrease sweep
-Increase ventilation to meet patient needs
-Weaning is successful when patient is stable at sweep of 0 for 4-24 hours (or MDs decision)

*Sweep of 0 = essentially off ECMO

Complications

Recirculation

Cardiac Arrest

Major Organizations

National Certification Exam
(CES-A)

Education

Membership

Guidelines

Registry

Training Course

Membership

List of ELSO Distinguished
Centers of Excellence

Course Structure

Students Pick Topic

Intro to ECMO

Protocol

Alfred Scenarios

Numbers and
Formulas Sheet

Perfusion Board Exam Materials

Other Modes of ECMO

COVID and ECMO Info

ELSO COVID Overview

I worked on this concept map on ECMO for a course through the University of Nebraska Medical Center. There are articles, videos, websites linked to different concepts (when underlined or icon on the side of each bubble), and also information on COVID ECMO. Please click around, explore and add me on LinkedIn. Try viewing the concept map as a slide show presentation, which presents the material in sequential order. All recommendations are welcomed. I hope this helps you learn more about ECMO.
Thank you - Jared W. Bienstock, MS, CCP, LP, CES-A

*Disclaimer: The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.