A New Direction in ECMO Complications: Bringing East-West Syndrome Into Focus

East-West Syndrome is not a term most ECMO clinicians will recognize — and that is exactly why Anna Marrocco believes this session is needed. Marrocco, a nurse practitioner in the CVICU at Henry Ford Health, and co-presenter Cristina Holmes, also at Henry Ford Health, will introduce attendees to a rare but clinically significant complication of venoarterial ECMO (VA-ECMO) that has only recently been described in the literature.

The session, “East-West Syndrome in ECMO: Implications for the Critical Care Nursing Practice,” will be at 10 a.m. on Monday.

While North-South Syndrome is well known among ECMO teams, East-West Syndrome has remained largely hidden. Marrocco and Holmes happened to learn about it after caring for a perplexing patient.

“We had this case that we couldn’t explain very well. We said, ‘What are we seeing? This is weird.’ In all honesty, we struggled with that patient because this is such a rarity.”

It was only later, when a research article crossed their desks, that they had a name for what they’d seen in that patient. Diving deeper, they found that one research article was about all that existed.

Their session helps define the syndrome’s attributes, clinical indicators and consequences. They’ll walk clinicians through the conditions that must be present for East-West Syndrome to occur, the predisposing factors and the subtle clinical signs that may be missed.

Confusion is often the first clue — but in an ICU patient on ECMO, it can have many potential causes. “They’re going to try to treat what they think they are seeing, but nothing is going to work,” Marrocco says. Standard blood gas results may point in one direction, but they can be misleading without additional sampling. That diagnostic mismatch is part of what makes the syndrome so difficult to recognize, she says.

Because the phenomenon is uncommon — Marrocco believes she has seen only that one clear case in more than a decade of work in the cardiac ICU — it is easy to overlook. Yet the consequences of missing it can be devastating.

The session emphasizes the critical role of bedside nurses, who are often the first to notice when “something is off.” Attendees will learn how to distinguish East-West Syndrome from more familiar complications, what diagnostic steps to take if they suspect it, and what to expect in managing the syndrome if the diagnosis is confirmed.

Ultimately, this session is foundational for clinicians who routinely care for VA-ECMO patients. Awareness is the first safeguard — and Marrocco hopes this early exploration sparks the broader research the ECMO nursing community still needs.