Refractory Hypoxemia on VV-ECMO: Repetition of a Structured Approach Is Paramount: A Case Report

A A Pract. 2023 May 5;17(5):e01677. doi: 10.1213/XAA.0000000000001677. eCollection 2023 May 1.


Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used to manage severe respiratory failure. Unfortunately, refractory hypoxemia often complicates VV-ECMO support. Both circuit- and patient-related etiologies can drive this, and a structured approach is necessary to diagnose and treat the condition. We present the case of a patient on VV-ECMO for acute respiratory distress syndrome who suffered from several distinct etiologies of refractory hypoxemia over a short timeframe. Frequent recalculation of cardiac output and oxygen delivery enabled early diagnosis and treatment of these conditions. We highlight the need for a structured and oft-repeated approach to this complex problem.

Publication types

  • Case Reports

MeSH terms

  • Extracorporeal Membrane Oxygenation*
  • Humans
  • Hypoxia / etiology
  • Hypoxia / therapy
  • Respiratory Distress Syndrome* / therapy
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / therapy