What is a recommended treatment for worsening hypercarbia on ECMO?

Worsening hypercarbia, which refers to elevated levels of carbon dioxide in the blood, can occur in patients on ECMO for various reasons, including inadequate ventilation or respiratory muscle fatigue. In such cases, one effective approach is to consider sedating or paralyzing the patient. This is particularly beneficial to ensure that the patient does not actively breathe against the ECMO circuit, which can impede optimal gas exchange and exacerbate hypercarbia.

By sedating or paralyzing the patient, the clinical team can maintain better control over ventilation parameters, ensuring the patient receives the appropriate level of mechanical support without the complications that can arise from spontaneous breathing efforts. This allows for more effective clearance of carbon dioxide and stabilization of the patient’s acid-base balance, ultimately helping to improve overall respiratory function and supporting the goals of ECMO therapy.

In contrast, actions such as ensuring inadequate ECMO flow or decreasing oxygen levels would not address hypercarbia effectively. Allowing spontaneous breathing could further complicate the situation by interfering with the ECMO circuit's efficiency, thus worsening the hypercarbia rather than alleviating it.