Venoarterial ECMO for AdultsJACC Scientific Expert Panel
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Author + information
- Maya Guglin, MD, PhDa,∗ (maya.guglin{at}uky.edu), @MGuglin,
- Mark J. Zucker, MDb,
- Vanessa M. Bazan, BBA, BSc,
- Biykem Bozkurt, MD, PhDd,
- Aly El Banayosy, MDe,
- Jerry D. Estep, MDf,
- John Gurley, MDa,
- Karl Nelson, MBA, RNe,
- Rajasekhar Malyala, MDg,
- Gurusher S. Panjrath, MDh,
- Joseph B. Zwischenberger, MDg and
- Sean P. Pinney, MDi
- aGill Heart Institute, University of Kentucky, Lexington, Kentucky
- bCardiothoracic Transplantation Programs, Newark Beth Israel Medical Center, Rutgers University-New Jersey Medical School, Newark, New Jersey
- cUniversity of Kentucky, Lexington, Kentucky
- dMichael E. DeBakey VA Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- eAcute Circulatory Support and Advanced Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
- fSection of Heart Failure & Transplantation, Cleveland Clinic Foundation, Cleveland, Ohio
- gDepartment of Surgery, University of Kentucky, Lexington, Kentucky
- hDivision of Cardiology, Department of Medicine, George Washington University, Washington, DC
- iDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address for correspondence:
Dr. Maya E. Guglin, Medical Director, Mechanical Circulatory Support Program, Division of Cardiovascular Medicine, Gill Heart & Vascular Institute, University of Kentucky Albert B. Chandler Hospital, First Floor, Suite G100, 800 Rose Street, Lexington, Kentucky 40536.
Central Illustration
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.
Footnotes
Dr. Zucker has reported that he has served on the scientific advisory board for and received honoraria from Alnylam and Pfizer. Dr. Bozkurt has served as a consultant for Lantheus and Bayer. Dr. Estep has served as a consultant for Abbott; and as a medical advisor for Medtronic. Dr. Zwischenberger has received licensed patent royalties for Avalon Elite double lumen cannula (Maquet); has received an industry grant from Xenios Austria GmBH; served as a partner to WZ Biotech; has served as a consultant for CytoSorb; has served on and as chair of Cytosorb Cardiac Advisory Board; and has received grant funding from the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received July 15, 2018.
- Revision received October 3, 2018.
- Accepted November 14, 2018.
- 2019 American College of Cardiology Foundation
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