As extracorporeal membrane oxygenation technology has evolved, interest in awake peripheral venoarterial extracorporeal membrane oxygenation has grown. This approach poses new challenges in patient monitoring. East-west syndrome is a clinically significant but easily overlooked phenomenon associated with awake venoarterial extracorporeal membrane oxygenation. It is characterized by a mismatch in carbon dioxide levels between the extracorporeal membrane oxygenation circuit and the body. Unlike north-south syndrome, which involves cranial-caudal differential hypoxia, east-west syndrome is characterized by variation in lateral blood flow to the brachiocephalic trunk, influencing carbon dioxide levels within cerebral circulation. Early recognition and management of east-west syndrome are key for patients undergoing awake venoarterial extracorporeal membrane oxygenation. Critical care nurses are vital to preventing complications in this patient population. The goal of this article is to increase awareness of this new phenomenon and prepare critical care nurses to optimize outcomes for patients undergoing extracorporeal membrane oxygenation.
