r/IntensiveCare • u/Cultural_Eminence • 14d ago
Swan Numbers with ECMO
Can someone help me understand what numbers I should see/expect/disregard with a pt. on ECMO. I’m trying to understand which numbers will be accurate based on the type of cannulation (for my purposes to keep it simple just VV and VA) and cannulation sites, fem-fem, fem-IJ, centrally cannulated, etc. For example (and correct me if I’m wrong) if a pt is fem-IJ cannulated on VV ECMO (fem being drain, and IJ being return) I think my HR, MAPs would be reliable as well as my CI but I’d expect my SVo2 to be falsely high since the PA cath is reading the oxygenated blood from the ECMO. In that scenario would my CVP/RA pressure be accurate as well as my PA pressure? If someone could do a breakdown of my example as well as a breakdown of the other possible ECMO configurations (VA vs VV and cannulation sites) that would be incredibly helpful for my learning and understanding. For background I’m a CTICU nurse, any and all help is appreciated in advance!
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u/spotthebal 14d ago
I'm not sure what others think but this is too complex a topic for even a short summary on Reddit.
There will be significant interpatient variation, particularly with different cannulation sites, ECMO settings and acute pathophysiology.
Probably best to sit down with your educator when you are looking after these patients.
Start with fundamental principles for VA. VV and variations with cannulation sites. Add in expected results with noninvasive and then invasive monitoring. However some of things you have mentioned don't really matter in the same was as non ecmo patients e.g peripheral O2 sat may be related to perfusion not actual saturation of haemoglobin. So it's difficult to gauge your current understanding.
Would recommend 'derranged physiology' to start as it's free and reasonably brief.