Episode 205: ECMO update with Drs. Essandoh, Cody and Graul

Extracorporeal Membrane Oxygenation (ECMO) serves as a critical life-support platform for patients experiencing refractory lung or heart failure. Veno-venous (VV) ECMO primarily supports lung function, utilizing cannulation strategies like femoral-femoral or the single-cannula Avalon approach to facilitate gas exchange. Conversely, Veno-arterial (VA) ECMO provides circulatory support by bypassing the heart, though it necessitates careful management of left ventricular distension, often requiring adjuncts like Impella devices or intra-aortic balloon pumps. Clinical monitoring, including transesophageal echocardiography and right-sided arterial lines, remains essential to detect complications such as limb ischemia, thromboembolism, and Harlequin syndrome. As ECMO applications expand, particularly in the context of COVID-19-related respiratory and cardiac dysfunction, clinicians must balance systemic anticoagulation needs against significant bleeding risks while prioritizing early mobilization and precise cannula positioning to optimize patient recovery.