ECMO-/ECLS

o Examples include:
 Tricuspid Atresia
 Pulmonary Atresia
 Tetralogy of Fallot with Pulmonary Atresia
 Severe Ebstein’s Anomaly
 Critical Pulmonary Stenosis
o In such situations, forward-flow Qp (ie, out the pulmonary artery) is absent
or severely limited. Thus, mixing of deoxygenated blood with oxygenated blood must
occur. This most often happens via a R  L shunt at the atrial level. This mixing will
lead to cyanosis.
o If atrial level mixing is insufficient and the pulmonary outflow obstruction is
severe, cyanosis may be profound. In such a scenario, an emergent atrial septostomy
may be needed to establish an alternate source of Qp.