Extracorporeal membrane oxygenation for end-stage heart failure

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for end-stage heart failure is a powerful tool to reverse acute shock and bridge a patient either to recovery, durable ventricular assist device (VAD), transplantation, or to extend a time for ongoing reevaluation of a patient’s clinical status. Patient selection is paramount. Patients without a reasonable chance for recovery or who are otherwise not candidates for advanced surgical therapy can have VA-ECMO initiation as a bridge to nowhere without an exit strategy. In this chapter, careful consideration is given to patients with heart failure requiring VA-ECMO in terms of patient selection, indications, management and auxiliary mechanical circulatory support (MCS) devices while on VA-ECMO.