Physiology I: Venovenous ECMO

Respiratory system physiology, oxygen transport physiology, and mechanisms that lead to respiratory failure are key to understanding the pathophysiology of patients that require venovenous ECMO (VV-ECMO) support. Venovenous ECMO injects oxygenated blood into the venous circulation providing support to the failing lungs. After VV-ECMO initiation, oxygenation and decarboxylation depend on the ECMO flow and its interaction with the cardiac output and the residual lung function. ECMO initiation provides organ support and promotes lung recovery by allowing less aggressive ventilation strategies that minimize ventilator-induced lung injury. The interaction between the patient and the extracorporeal circuit can lead to severe complications such as bleeding, thrombosis, and hemolysis. The care for VV-ECMO patients is complex and requires experienced teams knowledgeable in the early detection and management of arising ECMO-related complications, as well as in the management of the underlying disease.