Indications and physiopathology in venoarterial ECMO

Abstract

Circulatory failure refractory to conventional treatment is a fatal condition without circulatory support. Extracorporeal membrane oxygenation (ECMO) has emerged as the first-line therapy for many centers during this condition. Peripheral venoarterial ECMO (PVA-ECMO) has indeed many advantages as salvage therapy compared to other circulatory assistance systems: it can be implanted rapidly at patient’s bedside, even in remote locations, thanks to mobile ECMO teams. It allows a biventricular assistance with a high and stable blood flow, combined with a pulmonary assistance, making it suitable for most severe patients. Lastly, it is responsible for reasonable costs compared to other devices. Once implanted, ECMO will serve as a temporary support to bridge the patient to myocardial recovery, longterm assist device or heart transplantation depending on the potential of recovery of the underlying pathology.