V-VA: the heart just joined the problem

Handover

VV day 4 for viral ARDS. Overnight the RV dilated — MAP 46, lactate 4.6, D-sign, cool mottled knees. The arterial sheath is in. You can Y an arterial return onto this circuit (V-VA). The existing 21-Fr IJ return will steal everything unless you gate-clamp it. Leave at least a litre in each limb.