CV-EMCrit - MCS Minute Series: Differential Gas Exchange on Peripheral Femoral VA ECMO with Trina

This episode of EMCrit, featuring Trina Augustin, delves into the complexities of gas exchange management in patients undergoing peripheral VA ECMO, contrasting it with the more straightforward VV ECMO approach. The discussion emphasizes the critical, often overlooked, need to monitor both oxygenation and ventilation in VA ECMO patients due to the presence of two parallel circuits. A key point highlights the potential for differential carbon dioxide levels to cause metabolic alkalosis if post-oxygenator gas values are not closely monitored alongside right upper extremity ABGs. The speakers advocate for a comprehensive approach, including optimizing lung function through diuresis and lung-protective ventilation strategies, before resorting to more invasive interventions like additional cannulation.