Use of veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has become increasingly common as a means of providing hemodynamic support for patients in cardiogenic shock. Data regarding the efficacy of VA-ECMO are provided almost exclusively by single-center, retrospective analyses. These retrospective analyses vary significantly with regards to documentation of the underlying pathophysiologic process resulting in cardiogenic shock.
Relevant published studies were identified by using a comprehensive search of English-language MEDLINE from 1966 to November 2015. Relevant references found cited in these studies were also analyzed. These studies were analyzed with regard to the indications the authors used for initiation of ECMO, as well as the outcomes for each indication in each individual study.
Analysis of multiple relevant studies regarding the indications for ECMO support demonstrated that there is a great deal of variability with regard to the use of different indications for initiation of ECMO support.
Data regarding the efficacy of VA-ECMO is derived largely from single-center, retrospective analyses. In order to gain a better understanding of the efficacy of VA-ECMO in different patient populations, a more standardized format of documenting the indication for VA-ECMO should be used in centers that provide VA-ECMO. In general, all patients supported with VA-ECMO are in cardiogenic shock. In our experience, the underlying processes leading to cardiogenic shock can be classified as: cardiac arrest, acute decompensated congestive heart failure, acute on chronic congestive heart failure, myocardial infarction, acute pulmonary embolism, right ventricular failure not secondary to acute pulmonary embolism, and post-cardiotomy syndrome.
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Guglin, Maya and Burchett, Andrew
"VA-ECMO in Cardiogenic Shock in Adults: Indications and Outcomes,"
The VAD Journal: Vol. 2
, Article 8.
Available at: http://uknowledge.uky.edu/vad/vol2/iss1/8