Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Abstract

Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.

Early application of extracorporeal membrane oxygenation for myocarditis with shock: a case report

“… 16 ECMO can effortlessly prevent the deterioration of hemodynamics in patients with myocarditis and shock. 17 – 19 In fact, consistent with our case report, the registration of extracorporeal life support organizations indicates that early application of ECMO before cardiac arrest may give lead to outcomes. 14 …”

“…16 ECMO can effortlessly prevent the deterioration of hemodynamics in patients with myocarditis and shock. [17][18][19] In fact, consistent with our case report, the registration of extracorporeal life support organizations indicates that early application of ECMO before cardiac arrest may give lead to outcomes. 14 Regarding the advantages and disadvantages of each imaging tool, an ECG and echocardiogram are more convenient and less time-consuming than cardiac MRI.…”

Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis

“…A hollow fibre membrane oxygenator is spliced into the circuit, which not only provides blood oxygenation but also carbon dioxide (CO2) clearance via sweep gas flow. The latter function differentiates other MCS strategies, such as PLVADs and IABP [ 16 ]. Previously, strategies for LV unloading mainly included pulmonary vein or septal left atrial intubation, atrial septostomy, percutaneous mechanical circulatory support, transapical cannulation, or concomitant MCS devices, including IABP or PLVADs, such as Tandem-Heart [ 62 – 65 ].…”

“…Clinicians established the presence of CS by combining evidence of end-organ dysfunction and abnormal haemodynamic parameters. Most patients were diagnosed based on some combination of the following diagnostic criteria: (I) severe hypotension with systolic blood pressure (BP) < 80–90 mmHg for at least 30 min, the mean BP decreases by 30 mmHg or more from baseline, and vasoactive medications are needed to maintain the systolic BP above 90 mmHg in spite of sufficient fluid resuscitation; (II) elevated biventricular filling pressures with pulmonary capillary wedge pressure (PCWP) exceeding 15 mmHg and central venous pressure above 10 mmHg; (III) significantly reduced cardiac index (< 1.8 L/min/m 2 or < 2.2 L/min/m 2 with haemodynamic support); (IV) low mixed venous blood oxygen saturation signalling increased peripheral oxygen extraction due to hypoperfusion [ 13 , 16 ].…”

Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute—and know how to use all three

“…Myocardial ischemia and ischemic ventricular septal defect are some examples where this practice has been demonstrated with excellent results. 8 , 9 …”