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Key determinants of oxygen delivery during ECMO include circuit blood flow, cannula size and positioning, and hemoglobin concentration. Strategies for troubleshooting oxygenation issues are reviewed, including recirculation, increased oxygen consumption, and oxygenator dysfunction. In contrast, carbon dioxide removal (decarboxylation), which ECMO circuits efficiently achieve, is primarily influenced by sweep gas flow and the patient\u2019s systemic PaCO\u2082. Effective management of these factors is crucial to ensure optimal ECMO support, enable ultra-protective lung ventilation, and improve outcomes in critically ill patients with severe ARDS.<\/jats:p>","DOI":"10.4046\/trd.2025.0076","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T23:21:21Z","timestamp":1756423281000},"page":"634-642","update-policy":"https:\/\/doi.org\/10.4046\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimizing Extracorporeal Membrane Oxygenation Gas Exchange: Key Insights for Clinical Management"],"prefix":"10.4046","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3161-8711","authenticated-orcid":true,"given":"Sung 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