Veno-arterial extracorporeal membrane oxygenation

Despite improvements in reperfusion and adjunctive therapies cardiogenic shock associated with acute myocardial infarction is still associated with a mortality of 40-50%. Therefore, mechanical circulatory support devices are increasingly used. One option is veno-arterial extracorporal membrane oxygenation (VA-ECMO). VA-ECMO can be implanted percutaneously and blood is actively pumped into a tubing system outside the body which also incorporates an artificial lung for oxygenation and removal of carbon dioxide and then sent back retrograde in the aorta. This review summarizes the current evidence for the use of VA-ECMO in cardiogenic shock.

Four randomized clinical trials including the large ECLS-SHOCK trial with 417 patients and two individual patient data meta-analyses did not show any mortality benefit with the routine use of VA-ECMO, but a consistent increase in bleeding and peripheral vascular ischemic complications. So far, patients with STEMI and a low likelihood of brain injury might be an attractive group for the use of VA-ECMO. In addition patients in need for oxygenation might benefit from VA-ECMO.

The results of the ECLS-SHOCK trial and the meta-analyses call for a conservative approach regarding a routine unselected use of early VA-ECMO in patients with infarct-related cardiogenic shock.