PerfWeb 110 – Day 2 examines clinical indications for extracorporeal membrane oxygenation (ECMO) and available cannulation options, focusing on evidence-based criteria for initiation in adult patients with refractory cardiac or respiratory failure. This session addresses decision-making in high-acuity scenarios where standard therapies fail, providing perfusionists with tools to assess suitability and select appropriate access strategies. By clarifying when ECMO offers benefit versus risk, the content supports safer implementation in programs managing acute decompensations. Learning Objectives: Identify key clinical conditions, such as severe ARDS or cardiogenic shock, where ECMO provides effective temporary support. Differentiate between venoarterial (VA) and venovenous (VV) ECMO configurations based on underlying pathophysiology. Evaluate patient-specific factors influencing ECMO candidacy, including contraindications and prognostic indicators. Describe common cannulation sites and techniques, including peripheral versus central approaches. Apply strategies to mitigate cannulation-related complications like limb ischemia or recirculation. Interpret hemodynamic and gas exchange parameters to guide initial ECMO setup and adjustments.