ICU · Respiratory / ventilation

VA-ECMO for Cardiogenic Shock & Extracorporeal CPR (ECPR)

Also known as VA-ECMO · Veno-arterial ECMO · Extracorporeal life support · ECLS · Extracorporeal cardiopulmonary resuscitation · ECPR · Femoro-femoral ECMO · Harlequin syndrome · Differential hypoxaemia · LV distension · Bridge to recovery · SAVE score · SCAI shock stages · Distal perfusion cannula

Veno-arterial ECMO (VA-ECMO) drains venous blood, oxygenates and decarboxylates it, and returns it to the arterial system — providing both circulatory and respiratory support for refractory cardiogenic shock (a bridge to recovery, decision, transplant, or durable LVAD) and for refractory cardiac arrest (extracorporeal CPR, ECPR). Cannulation is peripheral (femoro-femoral, rapid, for shock and ECPR) or central. The complications include bleeding (the largest), limb ischaemia (mitigated by a distal perfusion cannula), left-ventricular distension and pulmonary oedema (the failing LV cannot eject against the retrograde aortic flow — may need an Impella or vent), differential hypoxaemia (the Harlequin or north-south syndrome), thrombosis, haemolysis, and infection. ECPR outcomes are best in selected, rapidly-cannulatable patients. Severity and reversibility are graded by the SCAI A-E stages and the SAVE score; weaning is by staged flow reduction with echocardiographic and pulse-pressure recovery assessment.