Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock

Abstract

Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high rate of complications and excessively high patient mortality, reported to be between 35% and 50%. Extracorporeal membrane oxygenation can provide full cardiopulmonary support, has been increasingly used in the last two decades, and can be used to restore systemic end-organ hypoperfusion. However, a paucity of randomized controlled trials in combination with high complication and mortality rates suggest the need for more research to better define its efficacy, safety, and optimal patient selection. In this review, we provide an updated review on VA-ECMO, with an emphasis on its application in cardiogenic shock, including indications and contraindications, expected hemodynamic and echocardiographic findings, recommendations for weaning, complications, and outcomes. Furthermore, specific emphasis will be devoted to the two published randomized controlled trials recently presented in this setting.

Counter-pulsation Control of a Pulsatile Extracorporeal Membrane Oxygenator Device using Deep Neural Networks for Blood Pressure Waveform Analysis

“…The heart model used in this study exhibits greater pressure variations compared to the pulse generated by the p-ECMO, attributed to the characteristic of p-ECMO, where the waveform size decreases and becomes more gradual as the pulse passes through the oxygenator. While standardized guidelines for the optimal settings of ECMO have not been established, several previous studies generally recommend ECMO ows in the range of 3-4 L/min, with a maximum of 6 L/min; the p-ECMO used in this study can provide a maximum average blood supply of 5 L/min according to its pulse rate, and similar IBP waveforms are expected to be observed in actual clinical settings [9,18,30]. In cases of a sudden decrease in HR of heart model, where the p-ECMO contribution rises to 70%, DNNs were trained using in-vitro experimental data, and it is anticipated that they will not signi cantly impact the heartbeat determination system driven by the DNN without employing speci c algorithms.…”

Neural Network-Driven Counter-Pulsation in Pulsatile Extracorporeal Membrane Oxygenator(ECMO): Enhancing Real-time Pulse Discrimination and Control Efficiency

“…While standardized guidelines for the optimal settings of ECMOs have not been established, several previous studies have generally recommended ECMO ows in the range of 3-4 L/min, with a maximum of 6 L/min. The p-ECMO used in this study could provide a maximum average blood supply of 5 L/min according to its pulse rate, and similar BP waveforms are expected to be observed in actual clinical settings [9,18,30]. In the case of a sudden decrease in the HR of the heart model, where the p-ECMO contribution increased to 70%, it was anticipated that they would not signi cantly impact the heartbeat determination system driven by the f-NNs without employing speci c algorithms.…”

ECMO in Myocardial Infarction-Associated Cardiogenic Shock: Blood Biomarkers as Predictors of Mortality

“…In a recently published review of va-ECMO support in the management of cardiogenic shock, the authors describe the existence of only two published randomized controlled trials to date examining va-ECMO support in patients with cardiogenic shock [43]. In the ECMO-CS trial, patients were randomized to va-ECMO support or conservative management, with the possibility of va-ECMO support in cases of hemodynamic deterioration.…”