Physiology of Extracorporeal Membrane Oxygenation

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) provides effective cardiopulmonary support in cardiogenic shock. Advances in membrane oxygenator technology and the relatively simple/rapid bedside deployment have led to greater adoption of this mechanical circulatory support modality. However, VA ECMO produces a non-physiological circulation with significant hemodynamic effects on the right and left heart systems. An understanding of the physiology of VA ECMO and the interaction with the right and left heart systems is fundamental to the management of VA ECMO. This Chapter will review the physiological concepts that are relevant to the clinical management of VA ECMO and summarize the clinical outcomes of VA ECMO support in cardiogenic shock.