How I Manage Drainage Insufficiency on Extracorporeal Membrane Oxygenation

While extracorporeal membrane oxygenation (ECMO) case volume continues to increase, management of patients receiving ECMO remains technically challenging. Iatrogenic injury is a potential contributor to complications and poor outcomes. Drainage insufficiency, wherein limited pump preload leads to reduced circuit blood flow, is ubiquitous, yet there is no consensus regarding treatment. We propose a physiology-based algorithmic approach to the management of drainage insufficiency.