VA ECMO Initial Setup and Management

Facility and Equipment Requirements

The American Thoracic Society recommends that a wet-primed ECMO circuit must be available 24/7 for immediate deployment, as circuit changes should occur in under 15 minutes during malfunction 1, 3
The Society of Critical Care Medicine suggests that an Uninterrupted Power System (UPS) supporting all equipment for a minimum of 45 minutes is necessary 1, 4
The American College of Cardiology recommends that backup components for all circuit elements be immediately accessible 1
Doppler echocardiography machines with physicians trained in vascular and cardiac echocardiography are necessary for cannulation guidance and surveillance, as recommended by the American Society of Echocardiography 1, 4

The American Association of Critical Care Nurses recommends a nurse-to-patient ratio of 1:1 to 1:2 maximum (one nurse for up to two ECMO patients) 1, 6, 4
The Extracorporeal Life Support Organization (ELSO) suggests that an ECMO program director (physician) is responsible for overall operations, training, equipment maintenance, and quality improvement 1, 6

The American Heart Association recommends targeting initial ECMO flow of 3-4 L/min immediately post-cannulation, gradually increasing as tolerated, with a strength of evidence level of B 7, 8
The European Society of Intensive Care Medicine suggests maintaining arteriovenous oxygen difference between 3-5 cc O₂/100ml blood as the most reliable flow parameter, with a strength of evidence level of C 7
The American College of Cardiology recommends targeting mean arterial pressure >70 mmHg to ensure adequate cerebral and end-organ perfusion while minimizing left ventricular afterload, with a strength of evidence level of A 7, 8

The Neurocritical Care Society recommends that protocolized neurological monitoring is mandatory, given that VA ECMO carries a 19% acute brain injury risk (versus 10% in VV ECMO) 2, 9, 7
The American Academy of Neurology suggests implementing continuous cerebral oximetry to detect acute brain injury early, especially for peripheral VA ECMO patients at risk for differential hypoxia, with a strength of evidence level of B 8

The Extracorporeal Life Support Organization (ELSO) recommends submitting data to the ELSO registry or equivalent database for cross-institutional analysis 6
The American College of Chest Physicians suggests holding formal multidisciplinary meetings routinely to analyze activity and review equipment needs, with a strength of evidence level of C 6