Heart Failure pp 289-298 | Cite as

Veno-Arterial ECMO

  • P. LeprinceEmail author
  • G. Lebreton
Part of the Cardiovascular Medicine book series (CVM)


Veno-arterial (VA) ecmo is an efficient circulatory support system to stabilize cardiogenic shock patients and bridge them to recovery, long term MCS or cardiac transplantation. Patient outcome will highly depend of shock etiology, timing of implantation and potential for heart function recovery. Moreover, VA ecmo is associated with several potentially devastating complications which can definitely impair the outcome of the patients if not efficiently prevented or treated. This is why, even if ecmo concept is very simple, management of ecmo patient requires a multidisciplinary team made of intensivist, surgeon, cardiologist and perfusionist as well as fully trained nurse staff.

Ecmo is the most efficient and the most adaptable short term circulatory support system but not the only one. There are indeed other systems like microaxial pumps which can be more suitable for specific situation. Thus, VA ecmo should be seen as part of a series of hemodynamic support tools which can be used separately, in continuity or even associated.

Finally, because ecmo implantation and even more patient management requires highly specialized team, the concept of ecmo network, mobile unit, and reference center is becoming critical and should be encouraged.


Ecmo Cardiogenic shock Circulatory support Cardiac transplantation Acute heart failure Cardiac arrest 


  1. 1.
    Bréchot N, Demondion P, Santi F, Lebreton G, Pham T, Dalakidis A, Gambotti L, Luyt CE, Schmidt M, Hekimian G, Cluzel P, Chastre J, Leprince P, Combes A. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2018;7(1):62–9.CrossRefGoogle Scholar
  2. 2.
    Petroni T, Harrois A, Amour J, Lebreton G, Brechot N, Tanaka S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Duranteau J, Combes A. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*. Crit Care Med. 2014;42(9):2075–82.CrossRefGoogle Scholar
  3. 3.
    Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, Esmailian F, Azarbal B. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97(2):610–6.CrossRefGoogle Scholar
  4. 4.
    Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008;372(9638):554–61.CrossRefGoogle Scholar
  5. 5.
    Le Guen M, Nicolas-Robin A, Carreira S, Raux M, Leprince P, Riou B, Langeron O. Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care. 2011;15(1):R29.CrossRefGoogle Scholar
  6. 6.
    Riou B, Adnet F, Baud F, Cariou A, Carli P, Combes A, Devictor D, Dubois-Randé JL, Gérard J-L, Gueugniaud P-Y, RicardHibon A, Langeron O, Leprince P, Longrois D, Pavie A, Pouard P, Rozé J-C, Trochu J-N, Vincentelli A. Recommandations sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Annales Françaises d’Anesthésie et de Réanimation. 2009;28:182–6.CrossRefGoogle Scholar
  7. 7.
    Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S, Hase M, Tahara Y, Atsumi T, SAVE-J Study Group. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014;85(6):762–8.CrossRefGoogle Scholar
  8. 8.
    Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, Kleinman ME, Kronick SL, Lavonas EJ, Link MS, Mancini ME, Morrison LJ, O’Connor RE, Samson RA, Schexnayder SM, Singletary EM, Sinz EH, Travers AH, Wyckoff MH, Hazinski MF. Part 1: executive summary: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 Suppl 2):S315–67.CrossRefGoogle Scholar
  9. 9.
    Demondion P, Fournel L, Golmard JL, Niculescu M, Pavie A, Leprince P. Predictors of 30-day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg. 2014;45(1):47–54.CrossRefGoogle Scholar
  10. 10.
    Muller G, Flecher E, Lebreton G, Luyt CE, Trouillet JL, Bréchot N, Schmidt M, Mastroianni C, Chastre J, Leprince P, Anselmi A, Combes A. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016;42(3):370–8.CrossRefGoogle Scholar
  11. 11.
    Mirabel M, Luyt CE, Leprince P, Trouillet JL, Léger P, Pavie A, Chastre J, Combes A. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med. 2011;39(5):1029–35.CrossRefGoogle Scholar
  12. 12.
    Dangers L, Bréchot N, Schmidt M, Lebreton G, Hékimian G, Nieszkowska A, Besset S, Trouillet JL, Chastre J, Leprince P, Combes A, Luyt CE. Extracorporeal membrane oxygenation for acute decompensated heart failure. Crit Care Med. 2017;45(8):1359–66.CrossRefGoogle Scholar
  13. 13.
    Jasseron C, Lebreton G, Cantrelle C, Legeai C, Leprince P, Flecher E, Sirinelli A, Bastien O, Dorent R. Impact of heart transplantation on survival in patients on venoarterial extracorporeal membrane oxygenation at listing in France. Transplantation. 2016;100(9):1979–87.CrossRefGoogle Scholar
  14. 14.
    Biancari F, Perrotti A, Dalén M, Guerrieri M, Fiore A, Reichart D, Dell’Aquila AM, Gatti G, Ala-Kokko T, Kinnunen EM, Tauriainen T, Chocron S, Airaksinen JKE, Ruggieri VG, Brascia D. Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients. J Cardiothorac Vasc Anesth. 2017.; pii: S1053-0770(17)30730-9.Google Scholar
  15. 15.
    D’Alessandro C, Golmard JL, Barreda E, Laali M, Makris R, Luyt CE, Leprince P, Pavie A. Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults. Eur J Cardiothorac Surg. 2011;40(4):962–9.PubMedGoogle Scholar
  16. 16.
    Bréchot N, Luyt CE, Schmidt M, Leprince P, Trouillet JL, Léger P, Pavie A, Chastre J, Combes A. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41(7):1616–26.CrossRefGoogle Scholar
  17. 17.
    Baud FJ, Megarbane B, Deye N, Leprince P. Clinical review: aggressive management and extracorporeal support for drug-induced cardiotoxicity. Crit Care. 2007;11(2):207. ReviewCrossRefGoogle Scholar
  18. 18.
    Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G. Intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–45.CrossRefGoogle Scholar
  19. 19.
    Pappalardo F, Schulte C, Pieri M, Schrage B, Contri R, Soeffker G, Greco T, Lembo R, Müllerleile K, Colombo A, Sydow K, De Bonis M, Wagner F, Reichenspurner H, Blankenberg S, Zangrillo A, Westermann D. Concomitant implantation of Impella(®) on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail. 2017;23(3):404–12.CrossRefGoogle Scholar
  20. 20.
    Mastroianni C, Bouabdallaoui N, Leprince P, Lebreton G. Short-term mechanical circulatory support with the Impella 5.0 device for cardiogenic shock at La Pitié-Salpêtrière. Eur Heart J Acute Cardiovasc Care. 2017;6(1):87–92.CrossRefGoogle Scholar
  21. 21.
    Thiele H, Sick P, Boudriot E, Diederich KW, Hambrecht R, Niebauer J, Schuler G. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26(13):1276–83.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Sorbonne UniversityAPHP, Groupe hospitalier Pitié SalpétrièreParisFrance

Personalised recommendations