What are the recommended flows for neoECMO?

• A. 50% of CO
• B. 80% of CO
• C. 100% of CO
• D. 20% of CO

Answer: (B)

In neoECMO, the goal is to provide enough systemic oxygen delivery while keeping the heart and lungs still contributing pulsatile flow. The ECMO circuit should carry most of the oxygenation burden, but not completely replace native output. Targeting about 80% of the patient’s native cardiac output achieves that balance: it delivers ample oxygen delivery to tissues without causing excessive LV afterload or distension that can occur if ECMO flow is pushed toward 100%. If flow is too low, oxygen delivery may be inadequate; if flow is too high, the increased afterload can impair native cardiac function and promote LV distension and edema. So, around 80% of cardiac output is the best compromise for neonates on ECMO.