Extracorporeal Membrane Oxygenation in Cardiogenic shock-A Review

Among various modalities to manage cardiogenic shock, mechanical support to heart and lung is still considered to be mainstay of the treatment. When there is evidence of inadequate tissue oxygen delivery despite intra-aortic balloon counterpulsation, invasive ventilation, and inotropes, full circulatory support is found to have a significant impact on the patient outcome.

A narrative review article discusses the significance of Extracorporeal membrane oxygenation (ECMO) in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery. This has been observed in a study in Journal of Cardiac Critical Care published by Scientific Scholar.

ECMO is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late-stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure.

ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options. Early initiation is the key to a successful outcome in cardiogenic shock.

A well-coordinated ECMO team is the core factor of management. So the authors ended by mentioning that as with any technology used in critically ill patients, end of life discussion and target of therapy and prognosis are equally essential.

Reference:

Nambiar PM, Sharma J, Mehta Y. Extracorporeal membrane oxygenation in cardiogenic shock – A review. J Card Crit Care 2023;7:35-9.