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Venoarterial extracorporeal membrane oxygenation in cardiogenic shock

indications, mode of operation, and current evidence

Pineton de Chambrun, Marca,b; Bréchot, Nicolasa,b; Combes, Alaina,b

Current Opinion in Critical Care: August 2019 - Volume 25 - Issue 4 - p 397–402
doi: 10.1097/MCC.0000000000000627
CARDIOGENIC SHOCK: Edited by Holger Thiele
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Purpose of review Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications, and discusses the results of recent case series and trials.

Recent findings VA-ECMO is utilized as a bridge to ‘decision’ that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support, and withdrawal in case of futility. VA-ECMO is considered the first-line TCS as it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella (Abiomed, Danvers, MA, USA) or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, and refractory cardiac arrest are among emerging indications for TCS.

Summary TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

aService de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié–Salpêtrière,

bSorbonne Université, INSERM, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France

Correspondence to Alain Combes, APHP, Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitie-Salpetriere, Paris, France. E-mail: alain.combes@aphp.fr

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