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Review
. 2025 Aug 1;31(4):473-479.
doi: 10.1097/MCC.0000000000001295. Epub 2025 Jun 12.

Veno-arterial extracorporeal membrane oxygenation

Uwe Zeymer  1   2 , Dirk Westermann  1
Affiliations
Review

Veno-arterial extracorporeal membrane oxygenation

Uwe Zeymer et al. Curr Opin Crit Care. .

Abstract

Purpose of review: Despite improvements in reperfusion and adjunctive therapies cardiogenic shock associated with acute myocardial infarction is still associated with a mortality of 40-50%. Therefore, mechanical circulatory support devices are increasingly used. One option is veno-arterial extracorporal membrane oxygenation (VA-ECMO). VA-ECMO can be implanted percutaneously and blood is actively pumped into a tubing system outside the body which also incorporates an artificial lung for oxygenation and removal of carbon dioxide and then sent back retrograde in the aorta. This review summarizes the current evidence for the use of VA-ECMO in cardiogenic shock.

Recent findings: Four randomized clinical trials including the large ECLS-SHOCK trial with 417 patients and two individual patient data meta-analyses did not show any mortality benefit with the routine use of VA-ECMO, but a consistent increase in bleeding and peripheral vascular ischemic complications. So far, patients with STEMI and a low likelihood of brain injury might be an attractive group for the use of VA-ECMO. In addition patients in need for oxygenation might benefit from VA-ECMO.

Summary: The results of the ECLS-SHOCK trial and the meta-analyses call for a conservative approach regarding a routine unselected use of early VA-ECMO in patients with infarct-related cardiogenic shock.

Keywords: cardiogenic shock; mechanical circulatory support; veno-arterial extracorporal membrane oxygenation.

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References

    1. Zeymer U, Bueno H, Granger CB, et al. Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: a document of the Acute Cardiovascular Care Association of the European Society of Cardiology. Eur Heart J Acute Cardiovasc Care 2020; 9:183–197.
    1. Thiele H, Ohman EM, de Waha-Thiele S, et al. Shock complicating myocardial infarction: an update. Eur Heart J 2019; 40:2671–2683.
    1. Zeymer U, Heer T, Ouarrak T, et al. Current spectrum and outcomes of infarct-related cardiogenic shock: insights from the CULPRIT-SHOCK registry and randomized controlled trial. Eur Heart J Acute Cardiovasc Care 2024; 13:335–346.
    1. Vallabhajosyula S, Prasad A, Sandhu GS, et al. Ten-year trends, predictors and outcomes of mechanical circulatory support in percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock. EuroIntervention 2021; 16:1254–1261.
    1. Lüsebrink E, Binzenhöfer L, Hering D, et al. Scrutinizing the role of venoarterial extracorporeal membrane oxygenation: has clinical practice outpaced the evidence? Circulation 2024; 149:1033–1052.

MeSH terms