ECMO Rounding Checklist

Paste Epic export or CCP report

Step 1 — Patient & ECMO type

Patient name or N/A

MRN or N/A

Date

ECMO configuration

Select the configuration before proceeding — controls which fields appear downstream.

Step 2 — Circuit parameters · VA ECMO

Flow L/min

RPM

Sweep L/min

FdO2 %

SvO2 %

Oxygenator

Resistance bands are not device-specific. The oxygenator label is recorded so the stored baseline is known to belong to this circuit.

Pressures

P1 mmHg

Pre-pump — enter negative

P2 pre mmHg

Pre-oxygenator

P2 post mmHg

Post-oxygenator

Transmembrane ΔP (TMLP)

P2 pre − P2 post

—

mmHg

Enter values

Transmembrane lung resistance (TMLR)

(P2 pre − P2 post) ÷ Flow

—

mmHg / (L/min)

Enter values

Circuit baseline

Enter an MRN — the first TMLR and ΔP recorded for that MRN become the reference for this circuit.

TMLR and ΔP bands are an institutional teaching heuristic — not literature-derived. Absolute thresholds are unreliable; interpret as a trend from the device baseline rather than a fixed cutoff.

Step 3 — Anticoagulation

AC status

Step 4 — Cannulae & circuit exam

Routine findings are pre-checked. Uncheck anything you did not examine, and use the red flag rows for abnormalities.

Return cannula (arterial)

Fr

Dressing intact No bleeding, no expanding hematoma

cm marking

Abnormal finding at site

Limb perfusion — cannulated leg

Pulses of the foot and leg palpable Doppler signals of the foot and leg detectable No signs of limb ischemia — warm, no mottling, cap refill intact

Signs of limb ischemia present

Drainage cannula (venous)

Fr

Dressing intact No bleeding, no expanding hematoma

cm marking

Abnormal finding at site

Circuit inspection

Clot

Connections secure — no kink or circuit compromise

Step 5 — Blood gas & chest X-ray · VA ECMO

Entire step is optional — anything left blank prints nothing.

Patient ABG — right radial preferred

Sample site

pH

PaCO2 mmHg

PaO2 mmHg

Post-oxygenator ABG — sampled from post-membrane port

pH

PaCO2 mmHg

PaO2 mmHg

PaCO2 — post-oxygenator vs patient

Flags: either value <32, or difference >12

—

mmHg difference

Enter values

Pulse oximetry

Right arm SpO2 %

Upper-body / native ejection compartment

Left arm SpO2 %

Variable — depends on mixing cloud position

Right-to-left arm SpO2 gradient

Flags on VA: right arm <92%, or left minus right ≥5

—

percentage points

Enter values

Chest X-ray

Step 6 — Hemodynamics & vent strategy

Pulsatility

Assessed from arterial line waveform pulse pressure. Also determines which ABG sample the differential hypocarbia line names as cerebrally relevant.

Vent strategy

Plan — select all that apply

Continue daily checks — no changes at this time, will continue to follow Monitor above issues — follow closely Circuit exchange recommended Oxygenator exchange recommended Vent strategy needed

Other

Blood gas, pulse oximetry, and clot-with-high-resistance findings append their own plan lines automatically — no checkbox needed.

Add critical care time attestation

Step 7 — Note · copy to Epic

For clinical use by qualified physicians only. Not a substitute for direct assessment.
2amccm.com · Dr. Jesse Shriki DO, MS, FACEP

Review — screen only, never copied into the note

Built from what you entered and what was in the paste. These are prompts to look, not determinations — thresholds are conventional or institutional, not guideline-derived. Nothing here is copied, saved, or written to the .docx.