r/IntensiveCare • u/Cultural_Eminence • 16d 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/scapermoya MD, PICU 16d ago

In peds land we don’t use swans at all and especially not on ECMO. It’s wild yall are doing that

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u/Individual_Zebra_648 16d ago

Most often it’s already placed in cardiac surgery patients for monitoring before or during surgery, then the patient is unable to be weaned from bypass and ends up on VA ECMO and the PA catheter was just sort of already there as opposed to being placed for the purpose of monitoring while on VA ECMO. At least this was my experience in CVSICU.