Key result
Peripheral VA-ECMO provides essential temporary support for refractory cardiogenic shock but requires careful patient selection.
Why the study?
With advances in ECMO technology and patient selection, peripheral VA-ECMO has expanded beyond postcardiotomy shock to diverse etiologies, warranting an updated overview of indications and perioperative considerations.
This review provides an updated overview of the evolving indications for peripheral VA-ECMO in cardiogenic shock and discusses perioperative implications for patients requiring surgery while on support.
Supports temporary MCS in refractory shock with selection caution; leaves open optimal perioperative protocols pending prospective trials.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of extracorporeal circulation that provides cardiopulmonary support in cardiogenic shock unresponsive to conventional therapy. Historically, VA-ECMO was limited to the operating room and primarily used to manage postcardiotomy cardiogenic shock cases. However, with advances in ECMO technology and a better understanding of patient selection criteria, VA-ECMO has expanded its role as a temporary and adaptable intervention in cardiogenic shock of diverse etiologies. This review provides an updated overview of the indications for peripheral VA-ECMO, discussing how recent studies have enhanced our understanding of when VA-ECMO should be considered. In addition, we discuss the feasibility of surgery during VA-ECMO support to improve perioperative planning and tailored anesthetic strategies following ECMO-related physiologic and pharmacological changes.
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Trieu et al. (2025) conducted a review in Cardiogenic shock. Peripheral VA-ECMO was evaluated. Peripheral VA-ECMO provides essential temporary mechanical circulatory support for patients with refractory cardiogenic shock across diverse etiologies, requiring careful patient selection.
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