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Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Recovery or Bridge to Heart Replacement Therapy in Refractory Cardiogenic Shock

  • Cardiogenic Shock: Progress in Mechanical Circulatory Support (JE Rame, Section Editor)
  • Published:
Current Heart Failure Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

The purpose of this review is to describe the outcomes following refractory cardiogenic shock (CS) requiring mechanical circulatory support and factors associated with successful and unsuccessful weaning from VA-ECMO. Based on the presented data, we will propose a weaning and bridging algorithm with the aim of facilitating this complex process.

Recent Findings

Refractory CS requiring VA-ECMO support is associated with high early mortality. Approximately 1/3 of the patients weaned from ECMO do not survive until hospital discharge. When evaluating the ability to wean from ECMO etiology of CS, hemodynamics, end-organ function, pulmonary blood oxygenation, metabolic status, and echocardiographic assessments must be considered. When cardiopulmonary function is not recoverable, heart replacement therapies (HRT) should be considered early as patients may have better outcomes.

Summary

Durable weaning from VA-ECMO is obtainable in well-selected patients. Patients should be separated from the ECMO circuit in the presence of myocardial recovery, hemodynamic stability, and restored end-organ function. If myocardial recovery is unsatisfactory (severe LV dysfunction), HRT should be considered early in suitable candidates. Future research is needed to identify predictors of sustained myocardial recovery.

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Authors and Affiliations

  1. Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA

    F. Sertic & C. Bermudez

  2. Department of Medicine, Sydney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    J. E. Rame

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Sertic, F., Bermudez, C. & Rame, J.E. Venoarterial Extracorporeal Membrane Oxygenation as a Bridge to Recovery or Bridge to Heart Replacement Therapy in Refractory Cardiogenic Shock. Curr Heart Fail Rep 17, 341–349 (2020). https://doi.org/10.1007/s11897-020-00495-7

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