Daily Care: Blood Pressure:

Blood Pressure:

  • The blood pressure should be measured invasively, traditionally in the right radial artery if the patient is on V-A ECMO.
  • Just like in any ICU patient, the MAP should be maintained at a high enough level to allow for adequate organ perfusion.
  • Vasopressors and inotropes may be used in ECMO patients in similar doses to patients who are not on ECLS.


  • The arterial line tracing of a patient on V-V ECMO should look like a traditional art-line tracing, and the patient should have a normal pulse pressure.
  • Changes in MAP have nothing to do with the flow, remember in V-V ECMO the pump provides no hemodynamic support.
  • Increases and decreases in MAP should be worked up in the same fashion as an ICU patient who is not on ECMO.


  • In V-A ECMO the flow from the pump is non-pulsatile, and the arterial line tracing loses a considerable amount of pulsatility.
  • We still target a MAP, just like in other ICU patients.
  • The jet of blood flow from the return cannula is retrograde and competes with the patient's native cardiac output, causing a huge afterload.
  • If the patient's heart cannot generate the force required to overcome this afterload, then the aortic valve will not open.
  • Pulse pressure and the presence of arterial line pulsations indicate some degree of opening of the aortic valve.
  • If there is no pulsatility in the arterial line then this may indicate the aortic valve is not opening, and this should be investigated further and corrected.

Intravascular Volume Status:

  • Interpreting a patient's intravascular volume status on ECMO is even more challenging that in a traditional ICU patient.
  • Intake and output should be monitored hourly.
  • Echocardiography (TTE or TEE) can be helpful in determining whether a patient will be fluid responsive by assessing ventricular filling.
  • The presence of chatter in the circuit may imply that the administration of fluid will generate an increase in output.
  • Fluids should only be given with the intent of improving the output of the pump and thereby improving oxygen delivery.
  • The CVP does not reflect fluid responsiveness or intravascular volume status in patients on ECLS.

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