What are the indications for initiating ECMO therapy in patients with cardiac failure?

Extracorporeal Membrane Oxygenation (ECMO) therapy is a life-saving intervention used in patients with severe cardiac failure when conventional treatments fail to provide adequate circulatory support. ECMO provides temporary mechanical support to the heart and/or lungs by circulating blood outside the body through an oxygenator that removes carbon dioxide and adds oxygen before returning it to the patient's bloodstream. Indications for initiating ECMO therapy in patients with cardiac failure include:

Refractory Cardiogenic Shock:ECMO may be considered in patients with refractory cardiogenic shock despite maximal medical therapy, including inotropes, vasopressors, and mechanical ventilation. Refractory shock is characterized by persistent hypotension, end-organ dysfunction, and signs of inadequate tissue perfusion despite aggressive hemodynamic support.

Myocardial Infarction with Cardiogenic Shock:ECMO can be used as a bridge to recovery or definitive therapy, such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), in patients with acute myocardial infarction complicated by cardiogenic shock who are unresponsive to conventional treatments.

Acute Fulminant Myocarditis:In patients with acute fulminant myocarditis causing severe hemodynamic instability and refractory cardiogenic shock, ECMO can provide temporary circulatory support while allowing time for myocardial recovery or considering other interventions such as cardiac transplantation.

Post-Cardiotomy Shock:ECMO may be initiated in patients who develop refractory cardiogenic shock following cardiac surgery (post-cardiotomy shock) despite intraoperative management and standard postoperative care. ECMO can stabilize hemodynamics and support cardiac function while allowing time for myocardial recovery or considering additional interventions.

Acute Decompensated Heart Failure:In patients with acute decompensated heart failure who fail to respond to medical therapy and require urgent circulatory support, ECMO may be used as a bridge to recovery, heart transplantation, or ventricular assist device (VAD) implantation.

High-Risk Percutaneous Coronary Intervention (PCI):ECMO can be utilized in patients undergoing high-risk PCI procedures, particularly those with severe left ventricular dysfunction, complex coronary anatomy, or hemodynamic instability, to provide circulatory support and minimize the risk of peri-procedural complications.

Cardiac Arrest:In selected cases of refractory cardiac arrest with potentially reversible causes, such as acute myocardial infarction or pulmonary embolism, ECMO may be considered as a rescue therapy to support circulation and facilitate cardiac and pulmonary recovery.

It's important to note that ECMO therapy is a complex and resource-intensive intervention associated with significant risks and complications, including bleeding, thrombosis, infection, and organ dysfunction. Therefore, patient selection, multidisciplinary team involvement, and careful consideration of potential benefits and risks are essential when considering ECMO for patients with cardiac failure. Additionally, ECMO therapy should be initiated promptly in appropriate cases to maximize its potential benefits and optimize patient outcomes.

Alok Kumar Bharti

Indication of initiation of ECMO for cardia failure is persistant low SBP < 90 mmHg on high inotropic support

Whatever is underlying cause is f any patients having persistent shock state despite high vasopressor support indication of initiation of ECMO

Rosetta Lobreglio

in acute heart failure that does not respond to inotropes with the patient deteriorating, it is time to start ECMO as a recovery or bridge to MCS or heart transplant

ECMO is initiated as Bridge to recovery or bridge to mechanical circulatory support or heart Transplant in setting of refractory shock due to any underlying cause

Haider Khalid Al-Fartosi

It is considered indicated in the setting of cardiopulmonary failure in patients with >80% expected mortality.

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