What's New in Veno-Arterial ECMO Indications?

Abstract

Peripheral venoarterial extracorporeal membrane oxygenation (PVA-ECMO) has become the first-line therapy in many centers during refractory circulatory failure. PVAECMO provides a rapid cardio-circulatory and pulmonary support at bedside, even in remote locations thanks to mobile ECMO teams, with reasonable costs. PVA-ECMO has been shown to be an effective salvage therapy in many different clinical situations with highly preserved quality of life among survivors. However outcome under PVA-ECMO strongly depends on underlying pathology. Myocarditis, primary graft dysfunction, refractory myocardial dysfunction associated with septic shock, and refractory cardiogenic shock following drug intoxication are associated with rapid myocardial recovery, and high survival rates (>70%). Cardiogenic shock following acute coronary syndrome and post-cardiotomy are associated with intermediary results in term of myocardial recovery and survival (40 to 50%). Many of such patients will need a bridge to heart transplantation or to long-term assist device. Out of hospital refractory cardiac arrest is associated with poor results (survival below 10%), questioning the potential futility of this technique in patients referred for this indication. Further studies are currently ongoing to better define ECMO indications as well as the optimal timing for ECMO implantation during refractory cardiogenic shock.