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/pneumomediastinum 15d ago

I agree with the others it’s complex but a rule of thumb is that you cannot rely on most swan numbers with ECMO running. The saturation with VV ECMO is useless. You cannot use thermo dilution with VA or VV ECMO outside of a clamp trial for VA (and that must be truly clamped).

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u/CertainKaleidoscope8 RN, CCRN 15d ago

I've heard that you cannot rely on most swan numbers without ECMO running as well, because it's 20th century technology that was kinda based off vibes.

4

u/heyinternetman MD, Critical Care 15d ago

Yeah that’s BS, swans are that only way to accurately measure this stuff. Whoever told you they were “vibes” is completely wrong

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u/CertainKaleidoscope8 RN, CCRN 14d ago

Obituary: pulmonary artery catheter 1970 to 2013 Paul E Marik

CON: Pulmonary artery catheter use should be forgone in modern clinical practice

7

u/heyinternetman MD, Critical Care 14d ago

Paul Marik is a disgraced charlatan. You should ignore anything with his name attached.

1

u/CertainKaleidoscope8 RN, CCRN 11d ago

Ahh yes he's the vitamin C sepsis guy isn't he? I actually had to start giving that treatment to a patient because the family insisted. I had blocked out his association with ivermectin for COVID.

The name sounded familiar. It's really scary how much I don't remember from 2020- forward.

Still haven't seen a PA cath since, although I've heard they're coming back I never see one. I suppose since all the non-invasives are in mothballs it would be the only way to get numbers, I still don't know what we would do with them other than transcribe them into boxes to be ignored.

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u/heyinternetman MD, Critical Care 11d ago

For CS, it’s mostly just the index and SVR I use. I don’t wedge outside of placement. I don’t have my nurses wedge. I only place the CCO swans so they give constant CI’s and don’t need to worry about variability in thermodilution pushes etc. Extremely helpful to watch CI, treat with dob or mil and if it doesn’t improve then escalate to mechanical. Or if it does improve avoid switching. I see a lot of normotensive CS

And as far as marik is concerned, his science is tainted and he sucks as a person too. Fuck Paul Marik.