Response to “Echocardiographic Predictors of Successful Extracorporeal Membrane Oxygenation Weaning after Refractory Cardiogenic Shock”

Venoarterial Extracorporeal Membrane Oxygenation Weaning in Refractory Cardiogenic Shock—Echocardiographic Guidance May Improve Success

“…Cardiogenic shock is a heterogeneous disease caused by acute myocardial infarction, postcardiotomy myocardial dysfunction, valvular heart disease, infectious myocarditis, and heart failure exacerbation, among others. [1][2][3][4][5][6] Contemporary insights into the pathophysiology of CS suggest that the transmission of elevated biventricular filling pressures to end organs causes cardiometabolic derangements. 6 Essentially, stunned and hibernating myocardium in CS reduces cardiac power output, increases pulmonary capillary wedge pressure, reduces pulmonary artery pulsatility index, and causes end-organ hypoperfusion, lactic acidosis, and, ultimately, death.…”

“…Critically, echocardiographic evaluation of ventricular recovery in CS should involve multiple indices for a comprehensive assessment. [1][2][3][4][5] In addition, advanced hemodynamic parameters such as cardiac power output, pulmonary capillary wedge pressure, and pulmonary artery pulsatility index can complement echocardiography in determining myocardial recovery. [1][2][3][4][5][6][7] Large, randomized, prospective, multicenter studies and guidelines are needed to determine the best echocardiographic parameters to guide separation from VA-ECMO and advance the care of CS patients.…”