Veno-arterial ECMO in cardiogenic shock and acute respiratory distress syndrome: Rationale and clinical objectives

Abstract

Several indications for veno-arterial extracorporeal membrane oxygenation (V-A ECMO) have been proposed including the acute respiratory distress syndrome in case of associated cardiogenic failure and heterogeneous cardiac pathology with symptoms of shock. Among these indications, some are rapidly reversible like poisonings or pulmonary embolism, while others may need longer time to recover, like peripartum myocardiopathy. In some situations, V-A ECMO represents a bridge to decision because neurological evaluation is impossible or recovery not warranted. For these reasons, V-A ECMO is often integrated in a more global decision process, going from bridge-to-recovery to bridge-to-transplantation with more aggressive assist devices.