Management of Patients Supported with Veno-Venous Extracorporeal Membrane Oxygenation

This chapter discusses various aspects of ventilator management, hemodynamic management, intravascular volume management, renal function, anticoagulation, sedation and pain management, nutrition, and infections in patients undergoing venovenous extracorporeal membrane oxygenation (VV ECMO) support. In ventilator management, the focus is on understanding the settings that promote lung recovery while minimizing ventilator-induced lung injury. Hemodynamic management aims to maintain adequate systemic blood flow and oxygen delivery during VV ECMO support. The management involves addressing hypotension, cardiac arrhythmias, pulmonary hypertension, and right ventricular dysfunction. In severe cases, switching to veno-arterial (VA) ECMO or other additional right ventricular support is an option. Volume management and renal support include optimizing diuresis, monitoring renal function, maintaining fluid balance, avoiding nephrotoxic medications, and using renal replacement therapy, if needed. The discussion addresses the challenges of anticoagulation management in ECMO patients, such as bleeding and clotting complications. The use of various anticoagulation options and the importance of monitoring anticoagulation levels is presented. Sedation and pain management are addressed to promote patient comfort and prevent complications. Nutrition management provides adequate support to promote healing, maintain muscle mass, and prevent complications. Close monitoring of electrolyte levels, glucose control, and fluid balance are important. Infection prevention involves diligent management of cannulae sites and appropriate dressing changes.