SCCM Resource Library-VA ECMO: Where Are the Data?

Video Transcription

Video Summary

In this video presentation, Dr. Lakshmi Sridharan discussed veno-arterial extracorporeal membrane oxygenation (VA ECMO), its indications, cannulation strategies, outcomes, and complications. VA ECMO is used to support patients with refractory shock, specifically cardiogenic shock, such as acute myocardial infarction or fulminant myocarditis. It can buy time for hemodynamic stability, improve end-organ perfusion, and reverse metabolic acidosis. Cannulation strategies for VA ECMO include peripheral (femoral) and central (ascending aorta) approaches. Peripheral cannulation is more common and allows for rapid deployment at the bedside, but can lead to concerns of distal ischemia. Complications of VA ECMO include stroke, bleeding, infection, neurologic events, kidney injury, coagulopathy, and hemolysis. Left ventricular (LV) distension is a major concern with femoral VA ECMO, as it can lead to increased wall stress and mechanical work, subendocardial ischemia, arrhythmias, and clot formation. LV decompression strategies, such as intra-aortic balloon pump or percutaneous ventricular assist devices, are crucial to manage LV distension. The use of VA ECMO in post-MI patients requiring surgical intervention does not show improvement in outcomes. The change in heart transplant allocation rules has resulted in increased use of VA ECMO as a bridging therapy for patients with decompensated acute-on-chronic heart failure awaiting transplantation. However, patients requiring VA ECMO post-transplant have worse one-year survival rates. Overall, improving hemocompatibility and biomaterials in the ECMO circuit, along with advancements in less invasive technologies, are areas of interest for future developments in VA ECMO management.

Asset Subtitle

Cardiovascular, Procedures, Quality and Patient Safety, 2022

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2022 Critical Care Congress held from April 18-21, 2022.

Meta Tag

Content Type Presentation

Knowledge Area Cardiovascular

Knowledge Area Procedures

Knowledge Area Quality and Patient Safety

Knowledge Level Advanced

Learning Pathway Cardiothoracic Critical Care

Membership Level Select

Tag Extracorporeal Life Support

Tag Evidence Based Medicine

Tag Extracorporeal Membrane Oxygenation ECMO

Tag Cardiothoracic Critical Care

Year 2022

Keywords

VA ECMO

cardiogenic shock

cannulation strategies

complications

LV distension

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