Title:Veno-Arterial Extracorporeal Membrane Oxygenation in the Adult: A Bridge to the State of the Art

VOLUME: 17 ISSUE: 4

Author(s):Marco Gennari*, Camilla L’Acqua, Mara Rubino, Marco Agrifoglio, Luca Salvi, Roberto Ceriani, Giancarlo Marenzi, Ivana Marana and Gianluca Polvani

Affiliation:IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan, IRCCS Centro Cardiologico Monzino, Milan

Keywords:ECMO, ECLS, cardiogenic shock, cardiac arrest, myocarditis, cardio-pulmonary support.

Abstract:Despite the technological advancements in the last 40 years, conditions such as refractory cardiogenic shock and cardiac arrest still present a very high mortality rate in real-world clinical practice.

In this light, we have reviewed the techniques, indications, contraindications, and results of the socalled Veno-Arterial Extracorporeal Circulatory Membrane Oxygenation (VA-ECMO) in the adult population to evaluate the current results of this temporary cardio-pulmonary support as salvage and/or bridge therapy in the patient suffering from refractory cardiogenic shock or cardio-circulatory arrest. The results are encouraging, especially in the setting of refractory cardiogenic shock and in-hospital cardiac arrest. Among a selected population, the prompt institution of a VA-ECMO may radically change the prognosis by sustaining vital functions while looking for the leading cause or waiting for the reversal of the temporary cardio-respiratory negative condition. The future directions aim to standardized and shared protocols, miniaturization of the machines, and possibly the institution of specialized “ECMO teams” for in and the out-of-hospital institution of the tool.