Newer indications for ECMO: Pulmonary embolism, pulmonary hypertension, septic shock and trauma

Abstract

New ECMO technology ensures safety in supporting special high-risk populations, previously excluded due to the fear of complications. In massive pulmonary embolism leading to cardiac arrest or cardiogenic shock, fast institution of ECMO can be lifesaving, buying time for diagnostic and therapeutic measures. Progressive right ventricular failure associated with pulmonary arterial hypertension, unresponsive to medical treatment, can be bridged to lung transplantation with ECMO support. Active physiotherapy is now feasible with the compact ECMO technology and has been shown to improve long-term survival in these patients. Adult septic shock can be supported with peripheral V-A ECMO in the case of life-threatening septic cardiomyopathy leading to cardiogenic shock. When ARDS is present, hybrid ECMO configurations (V-V/V-A dual ECMO) or central ECMO must be used; otherwise, the problem of differential oxygenation (“harlequin syndrome”) will ensue. Finally, extracorporeal support has been used recently in trauma patients actively bleeding and with traumatic brain injury withholding anticoagulation in the acute phases, challenging previous relative and absolute contraindications to ECMO.