From the Guidelines
Cardiac Extracorporeal Membrane Oxygenation (ECMO) is a life-saving advanced cardiac support technique that temporarily takes over heart and lung function in patients with severe cardiac failure, as supported by the most recent study in 2024 1.
Overview of Cardiac ECMO
It works by removing blood from the patient's body, passing it through an artificial lung (oxygenator) where carbon dioxide is removed and oxygen is added, and then returning the oxygenated blood back to the patient's circulation.
- There are two main types:
- Veno-arterial (VA) ECMO, used for cardiac support where blood is removed from a vein and returned to an artery, providing both cardiac and respiratory support.
- Veno-venous (VV) ECMO, used primarily for respiratory failure where blood is removed from and returned to veins.
Indications and Usage
Cardiac ECMO is typically used as a bridge to recovery, cardiac transplantation, or implantation of a ventricular assist device in cases of cardiogenic shock, post-cardiotomy failure, acute myocarditis, or during cardiac arrest, as noted in earlier studies 1.
- The procedure requires anticoagulation (typically with heparin) to prevent clotting in the circuit, and patients need careful monitoring for complications including bleeding, thrombosis, infection, and limb ischemia.
Management and Outcomes
ECMO is a temporary support measure, usually maintained for days to weeks, requiring a specialized team including cardiac surgeons, intensivists, perfusionists, and specialized nurses in centers equipped to handle this complex therapy.
- Recent studies in 2024 highlight the importance of systematic post-cardiac arrest management strategies and the need for better understanding of hemodynamic, neurological, and metabolic abnormalities to improve outcomes in ECPR patients 1.
From the Research
Cardiac Extracorporeal Membrane Oxygenation (ECMO)
Cardiac ECMO, also known as extracorporeal life support systems (ECLS), is a medical therapy used to support the heart and lungs in patients with severe cardiac or respiratory failure.
- It involves the use of a machine that oxygenates the blood and removes carbon dioxide outside of the body, allowing the heart and lungs to rest and recover 2.
- Cardiac ECMO can be used in various clinical scenarios, including postcardiotomy shock, cardiogenic shock, and severe cardiac failure due to conditions such as cardiomyopathy, myocarditis, or acute coronary syndrome 3, 4.
- There are two main types of ECMO configurations: veno-venous (VV) ECMO, which provides respiratory support, and veno-arterial (VA) ECMO, which provides both cardiac and respiratory support 2, 4.
- VA ECMO is typically used in patients with cardiac failure, while VV ECMO is used in patients with respiratory failure, such as adult respiratory distress syndrome (ARDS) or pneumonia 4.
- The use of ECMO has been shown to be effective in providing temporary support to patients with severe cardiac or respiratory failure, allowing them to recover or undergo further treatment, such as heart transplantation 3, 5, 6.
Indications for Cardiac ECMO
The indications for cardiac ECMO include:
- Cardiogenic shock
- Severe cardiac failure due to conditions such as cardiomyopathy, myocarditis, or acute coronary syndrome
- Postcardiotomy shock
- Refractory cardiac arrest
- Bridge to heart transplantation or other durable mechanical circulatory support devices 3, 2, 4, 5, 6.
Outcomes and Complications
The outcomes and complications of cardiac ECMO vary depending on the patient's underlying condition and the duration of ECMO support.
- Overall, the use of ECMO has been shown to be effective in providing temporary support to patients with severe cardiac or respiratory failure, with some studies reporting survival rates of up to 54.5% 5.
- However, ECMO is not without complications, and patients may experience bleeding, infection, and other adverse events during ECMO support 4, 5.