Extracorporeal Membrane Oxygenation for Acute Cardiogenic Shock

Veno-arterial extracorporeal membrane oxygenation (ECMO) is utilised as a short-term mechanical circulatory assist device for treatment of refractory acute cardiogenic shock. After a period of support, called “bridge to decision”, the options for ensuing therapy include weaning from ECMO, switch to a long-term ventricular assist device, or heart transplantation, depending on the occurrence of myocardial recovery and the presence of comorbidities. The femoral vessels are the standard access for implantation. The subclavian artery or central cannulation are the alternatives in peripheral artery disease. Early survival rates amount to approximately 40%. Patients who survived the early period have a good long-term survival. The poor outcome of ECMO therapy results from the high frequency of complications, including vascular, bleeding, neurological, infectious and renal adverse events, as well as from the particular circumstances of cardiogenic shock. The condition triggers a cascade of systemic inflammation, which is aggravated depending on the duration of the hypotensive period. The extent of the subsequent multiorgan dysfunction syndrome substantially affects outcome. As a consequence, early ECMO implantation is advocated. In unclear neurological conditions and severely compromised end-organ function, the anticipated poor outcome has to be weighed very carefully against ethical and economical aspects before ECMO is initiated.