Veno-arterial ECMO: insertion and management state of the art

• Pascal Leprince

Abstract

ECMO (extra corporeal membrane oxygenation) is a very simple system which allows to derive the systemic venous blood through a centrifugal pump into an oxygenator and then infusing the oxygenated/decarboxylated blood through an outflow canula. ECMO can be used as pure respiratory support or cardiorespiratory support whether the outflow canula is inserted into the venous systemic compartment (veno-venous) or into the arterial systemic one (veno-arterial). In this paper we will focus only on veno-arterial (VA) ECMO. Throughout the last 10 years, VA ECMO became the first line mechanical circulatory support system for patients with profound cardiogenic shock. In acute situation, ECMO has the advantage of allowing fast implantation. Indeed, the femoro-femoral implantation can be performed bedside without transferring the patient to the OR, even in a noncardiac surgery centre. Moreover, VA ECMO supports the failure of both ventricles as well as respiratory failure related to pulmonary edema which is frequent in acute heart failure. Another important specificity of ECMO is the cost. Indeed, in comparison to other long term or even short term support devices, ECMO remains cheap enough to allow giving a chance even in very high risk patients.

Even if ECMO is a simple concept, insertion as well a management require well trained and skilled team to give the maximum chance to very seek patients and to avoid as much as possible ECMO related complications. This is what we will focus on in the following text. This manuscript will show very few bibliographic reference since it is mainly based on our experience of ECMO in La Pitiе-Salpеtriеre cen- tre with more than 1500 ECMO implantations over the last 10 years.

Keywords:cardiogenic shock, extra corporeal membrane oxygenation (ECMO)

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