**9.6 Sepsis-induced cardiomyopathy and Use of ECMO**

Sepsis is a potentially life-threatening condition that occurs due to systemic dysregulated inflammation secondary to overwhelming infection, which affects various organs [125]. An important complication of severe sepsis is sepsis-induced cardiomyopathy (SIC), which is reversible depression of myocardium [126]. This occurs due to structural damage and dysfunction of the myocardium caused by widespread inflammatory cytokine release and mitochondrial dysfunction [127]. There are three characteristics of SIC: dilation of the left ventricle (LV), reduced EF (ejection fraction), and reversibility of cardiomyopathy in 7–10 days after the resolution of sepsis [128]. With improvement in the understanding of molecular biology, our understanding of SIC has significantly improved in last few decades. Although the use of ECMO is increasing in the treatment of various cardiac and noncardiac conditions, it has not been treated as standard practice protocol for adult patients with septic shock, unlike pediatric and neonatal patients [129–132]. Despite the ECMO has gained wide acceptance for the treatment of adult respiratory distress syndrome (ARDS), the effectiveness of ECMO in treating septic shock still remains controversial [129, 133]. In this section, we will discuss SIC and the viability of ECMO as a treatment option.
