Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 4:12:2022-7-7.
doi: 10.7573/dic.2022-7-7. eCollection 2023.

Emerging concepts in heart failure management and treatment: circulatory support with extracorporeal membrane oxygenation (ECMO)

Federico Swedzky  1 , Alejandro Barbagelata  2   3 , Sergio Perrone  2   4 , Edgardo Kaplinsky  5 , Anique Ducharme  1
Affiliations
Review

Emerging concepts in heart failure management and treatment: circulatory support with extracorporeal membrane oxygenation (ECMO)

Federico Swedzky et al. Drugs Context. .

Abstract

Circulatory support with extracorporeal membrane oxygenation (ECMO) is being increasingly used in several critical situations but evidence of its impact on outcomes is inconsistent. Understanding of the specific indications and appropriate timing of implantation of this technology might lead to improved results. Indeed, the line between success and futility may be sometimes very thin when facing a patient in critical condition. New techniques with lighter, simpler and effective devices are being developed. Hence, ECMO has become an accessible technology that is being increasingly used outside of the operating room by heart failure specialists, critical care cardiologists and intensivists. Proper timing of utilization and choice of device may lead to better outcomes. We herein aim to improve this knowledge gap by conducting a literature review to provide simple information, evidence-based indications and a practical approach for cardiologists who may encounter acutely ill adult patients that may be ECMO candidates. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

Keywords: cardiac arrest; cardiac arrhythmias; cardiogenic shock; extracorporeal membrane oxygenation; heart failure; heart transplantation; myocardial infarction; myocarditis; pulmonary embolism.

PubMed Disclaimer

Conflict of interest statement

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/12/dic.2022-7-7-COI.pdf

Figures

Figure 1
Figure 1. Venoarterial ECMO as a bridge
Left panel – Clinical scenarios: (A) In refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation); (B) in cardiogenic shock associated with acute myocardial infarction; (C) in the setting of acutely decompensated chronic heart failure, myocarditis, etc.; or (D) in arrhythmic storm. Right panel – Goals of support: (I) RECOVERY; (II) durable left ventricular assist device; (III) cardiac transplantation, or (IV) undetermined (bridge to decision, candidacy).
Figure 2
Figure 2. Peripheral VA-ECMO
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass device that allows circulatory and respiratory supports. Using a centrifugal pump with a gas exchange system, venoarterial (VA)-ECMO permits adequate cardiac output, degree of oxygenation and CO2 extraction. The most frequently used access site is the femoral artery.
Figure 3
Figure 3. Contemporary, commercially available percutaneous left ventricular (upper panel) and right ventricular (lower panel) mechanical support devices
ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump. Reproduced with permission from Mandawat A, Rao SV. Percutaneous mechanical circulatory support devices in cardiogenic shock. Circ Cardiovasc Interv. 2017;10:e004337. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004337
Figure 4
Figure 4. Meta-analysis of mortality in patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) with versus without left ventricular unloading
Reproduced with permission from Russo JJ, Aleksova N, Pitcher I, et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J Am Coll Cardiol. 2019;73(6):654–662. https://doi.org/10.1016/j.jacc.2018.10.085
See this image and copyright information in PMC

References

    1. Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults. J Am Coll Cardiol. 2019;73(6):698–716. doi: 10.1016/j.jacc.2018.11.038. - DOI - PubMed
    1. Richardson AC, Tonna JE, Nanjayya V, et al. Extracorporeal cardiopulmonary resuscitation in adults. Interim guideline consensus statement from the extracorporeal life support organization. ASAIO J. 2021;67(3):221–228. doi: 10.1097/MAT.0000000000001344. - DOI - PMC - PubMed
    1. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63(25):2769–2778. doi: 10.1016/j.jacc.2014.03.046. - DOI - PubMed
    1. Zarragoikoetxea I, Pajares A, Moreno I, et al. Documento de consenso SEDAR/SECCE sobre el manejo de ECMO. Cir Cardiovasc. 2021;28(6):332–352. doi: 10.1016/j.circv.2021.06.006. - DOI
    1. Pavlushkov E, Berman M, Valchanov K. Cannulation techniques for extracorporeal life support. Ann Transl Med. 2017;5(4):70. doi: 10.21037/atm.2016.11.47. - DOI - PMC - PubMed