BACKGROUND: Management of VA ECMO has substantially evolved over the years. Much literature has been published regarding indications, management, and outcomes; however, limited evidence exists detailing strategies to manage, progress, and wean patients from VA ECMO. We present our experience using a VA ECMO expected progression patient management guideline. METHODS: The VA ECMO Expected Progression Patient Management Guideline, approved on June 1, 2021, consists of six goal-oriented stages with suggestive interventions for managing cardiogenic shock patients undergoing VA ECMO therapy. Patient characteristics and outcomes were collected retrospectively and compared between March 2019 to May 2021 (VA Non-Expected Progression group) and June 2021 to February 2024 (VA Expected Progression group). RESULTS: Patient characteristics and outcomes are shown in Table 1. Of 93 adult patients, 75 followed the VA ECMO expected progression patient management guideline. There was no significant difference in age, ethnicity, and BMI. Pre-ECMO characteristics were evenly distributed except with at least one inotrope and SAVE score variable in the VA Non-Expected group. Mean ECMO duration, ICU length of stay (LOS), and hospital LOS were shorter in the VA Expected Progression group. Hospital discharge outcome measures demonstrated an increase of 18% in the VA Expected Progression group. Conclusion: This management guideline is a helpful tool that has resulted in streamlined care, shorter ECMO runs, decreased LOS, and improved outcomes. Further studies with adequate sample size are needed to evaluate the effect of protocol implementation on length of stay and survival.