• Stuart A Gillon, Nicholas A Barrett, Nicholas Ioannou, Luigi Camporota, Kelly Victor, Abigail Gowland, Christopher I S Meadows, Christopher Langrish, Stephen Tricklebank, and Duncan Wyncoll.
• 1Department of Intensive Care, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. 2Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
• Crit. Care Med. 2016 Jul 1; 44 (7): e583-6.

ObjectivesVeno-venous extracorporeal membrane oxygenation is an increasingly used form of advanced respiratory support, but its effects on the physiology of the right heart are incompletely understood. We seek to illustrate the impact of veno-venous extracorporeal membrane oxygenation return blood flow upon the right atrium by considering the physiologic effects during interatrial shunting.PatientsTwo veno-venous extracorporeal membrane oxygenation patients in whom an extracorporeal membrane oxygenation induced right-to-left interatrial shunt appears to have created a barrier to liberation from extracorporeal support.ConclusionsVeno-venous extracorporeal membrane oxygenation return flow generates a high-pressure jet that has potential to exert focal pressure upon the intra-atrial septum. In patients with potential for interatrial flow, this may lead to a right-to-left shunt, which becomes physiologically apparent only when sweep gas flow is ceased.

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