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.
Highlights
The primary objective of this paper is to provide a comprehensive review of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in the management of adult patients with refractory cardiogenic shock (CS).THE EVOLVING DEFINITION OF CARDIOGENIC SHOCKCardiogenic shock is commonly defined as a state of low cardiac output that is inadequate to support the systemic perfusion requirements in the context of normal cardiac filling pressures
Many other groups have reported high weaning and hospital discharge rates, establishing Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as an extremely effective strategy for the management of patients with fulminant myocarditis associated with hemodynamic collapse [87,88,89,90,91,92,93,94,95,96,97,98,99,100] (Table 2)
Patients are prone to large hematoma formation even in the setting of minor vascular injury owing to the systemic anticoagulation employed for the VA-ECMO circuit
Summary
Cardiogenic shock is commonly defined as a state of low cardiac output that is inadequate to support the systemic perfusion requirements in the context of normal cardiac filling pressures. The presence of low SVR may signify end-stage CS as a result of inappropriate vasodilation despite hypotension, low cardiac output, and tissue hypoperfusion. It is associated with microvascular dysfunction, more severe systemic inflammatory response (cytokine storm) and, worse clinical outcomes [22]. It became increasingly clear that the clinical condition of patients meeting the minimum criteria of CS are extremely heterogenous It may include outpatients with low cardiac output, those requiring a single inotrope infusion as well as end stage patients needing biventricular mechanical circulatory support (MCS). Utilizing this strategy is expected to reduce complications, improve clinical outcomes, and survival
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