Veno-Arterial Extracorporeal Membrane Oxygenation ‘Plus’

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an effective modality for hemodynamic support in cardiogenic shock. However, two VA ECMO-specific complications may arise from the non-physiological circulation—left ventricular (LV) distension and differential hypoxemia. The Impella device has been used to unload the LV to address the problem of LV distension; while the addition of venous return to the pulmonary circulation (veno-arterial-venous ECMO) has been used to correct differential hypoxemia. Impella support in addition to VA ECMO (some have called it ‘Ecpella’) and VAV ECMO will be discussed in this Chapter of VA ECMO ‘plus’.