Extracorporeal support in cardiogenic shock with veno-arterial ECMO

Cardiogenic shock (CS) is a multifactorial pathological process with high morbidity and mortality. When it occurs in relation to the perioperative environment of cardiovascular surgery, elements such as the cause of the surgery (preoperative), the procedure performed (intraoperative), anesthetic events, and early and late postoperative pathophysiological phenomena (postoperative) can negatively affect patient outcomes. In this context, and as a consequence of the great heterogeneity of pathophysiological phenomena related to a single or several causes of cardiogenic shock (pre, intra and postoperative), a multidisciplinary approach that encompasses all aspects of the patient's clinic is essential to decide the most appropriate treatment for each scenario, evaluating the risks of each treatment, as well as projecting a possible evolution of the condition. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides more robust hemodynamic support and oxygenation than other supports, partially or totally replacing the patient's cardiac and respiratory systems. Peripheral VA-ECMO can be quickly installed at the bedside in severely unstable patients. VA-ECMO has the unique advantage of serving as a stable support in the event of cardiogenic shock following cardiotomy and can be easily converted from cannula insertions to cardiopulmonary bypass, providing a bridge to decision making. The choice of the appropriate configuration (peripheral or central) will depend, therefore, on the cause that generated the cardiogenic shock and the acuteness of the condition, so the most appropriate management strategy must be carried out by a multidisciplinary team in order to ensure an early diagnosis and treatment and guarantee the preservation of myocardial function by considering all the possible complications derived from each type of support.