Korean Circ J.  2019 Aug;49(8):657-677. 10.4070/kcj.2019.0188.

Clinical Pearls of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Korea.
  • 2Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. yanghyun.cho@samsung.com

Abstract

Extracorporeal membrane oxygenation (ECMO) is a technique that uses a pump to drain blood from a body, circulate blood through a membrane lung, and return the oxygenated blood back into the body. Venoarterial (VA) ECMO is a simplified version of the heart-lung machine that assists native pulmonary and/or cardiac function. VA ECMO is composed of a drainage cannula in the venous system and a return cannula in the arterial system. Because VA ECMO can increase tissue perfusion by increasing the arterial blood flow, it is used to treat medically refractory cardiogenic shock or cardiac arrest. VA ECMO has a distinct physiology that is referred to as differential flows. It can cause several complications such as left ventricular distension with pulmonary edema, distal limb ischemia, bleeding, and thromboembolism. Physicians who are using this technology should be knowledgeable on the prevention and management of these complications. We review the basic physiology of VA ECMO, the mechanism of complications, and the simple management of VA ECMO.

Keyword

Extracorporeal membrane oxygenation; Physiology; Shock; Postoperative complications

MeSH Terms

Catheters
Drainage
Extracorporeal Membrane Oxygenation*
Extremities
Heart Arrest
Heart-Lung Machine
Hemorrhage
Ischemia
Lung
Membranes
Oxygen
Perfusion
Physiology
Postoperative Complications
Pulmonary Edema
Shock
Shock, Cardiogenic*
Thromboembolism
Oxygen
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