Should ECMO be used in cardiogenic shock?

Excerpt

We read the compilation of Hajjar et al. with interest [1]. Cardiogenic shock is the clinical expression of circulatory failure, because of left, right, or biventricular dysfunction. One of the most common applications to eliminate circulatory failure is the extracorporeal membrane oxygenation (ECMO), as stated by the authors. Theoretically, ECMO will provide the necessary circulatory support. However, it is unrealistic to expect ECMO to improve cardiac functions in a patient with cardiogenic shock. A veno-arterial (VA) ECMO that is applied in the case of a cardiogenic shock due to left ventricular (LV) failure is almost impossible to improve LV functions. Because, in order to improve myositis damage in a failing ventricle, the wall tension of the ventricle must be decreased. This is only possible by venting or in other words unloading the failing ventricle. However, it cannot be expected that the VA-ECMO can vent the left ventricle. …