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J Am Coll Cardiol. 2019 Feb 19;73(6):698-716. doi: 10.1016/j.jacc.2018.11.038.

Venoarterial ECMO for Adults: JACC Scientific Expert Panel.

Author information

1
Gill Heart Institute, University of Kentucky, Lexington, Kentucky. Electronic address: maya.guglin@uky.edu.
2
Cardiothoracic Transplantation Programs, Newark Beth Israel Medical Center, Rutgers University-New Jersey Medical School, Newark, New Jersey.
3
University of Kentucky, Lexington, Kentucky.
4
Michael E. DeBakey VA Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas.
5
Acute Circulatory Support and Advanced Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma.
6
Section of Heart Failure & Transplantation, Cleveland Clinic Foundation, Cleveland, Ohio.
7
Gill Heart Institute, University of Kentucky, Lexington, Kentucky.
8
Department of Surgery, University of Kentucky, Lexington, Kentucky.
9
Division of Cardiology, Department of Medicine, George Washington University, Washington, DC.
10
Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.

Abstract

Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise, with or without respiratory failure, for days or weeks. In cardiology, the main indications for ECMO include cardiac arrest, cardiogenic shock, post-cardiotomy shock, refractory ventricular tachycardia, and acute management of complications of invasive procedures. The fundamental premise underlying ECMO is that it is a bridge-to recovery, to a more durable bridge, to definitive treatment, or to decision. As a very resource- and effort-intensive intervention, ECMO should not be used on unsalvageable patients. As the use of this technology continues to evolve rapidly, it is important to understand the indications and contraindications; the logistics of ECMO initiation, management, and weaning; the general infrastructure of the program (including the challenges associated with transferring patients supported by ECMO); and ethical considerations, areas of uncertainty, and future directions.

KEYWORDS:

ECLS; cardiac arrest; cardiogenic shock

PMID:
30765037
DOI:
10.1016/j.jacc.2018.11.038

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