Author: Sana Ullah, MB ChB, FRCA – Dallas, TX


A 16-year-old, 65 kg adolescent male is placed on peripheral veno-arterial (VA) extracorporeal membrane oxygenation via the left femoral artery and the right femoral vein due to acute fulminant myocarditis. Following five days of ECMO, a transthoracic echocardiogram demonstrates improved left ventricular function with an epinephrine infusion of 0.05 mcg/kg/min. Pulse oximetry on the right arm and right leg demonstrates oxygen saturations of 60% and 96% respectively. Non-invasive cerebral oximetry has decreased from 80 to 40 with a fractional inspired oxygen of 1.0 and a chest x-ray demonstrating appropriate endotracheal tube position. What is the MOST APPROPRIATE clinical intervention at this time ?