**9.11 Concurrent management along with ECMO**

In a patient with SCM supported by VA-ECMO, apart from managing ECMO, other important goals are augmentation of cardiac output, ventilator management, anticoagulation, and hemodynamic support [163]. Ventilation parameters should promote "lung rest" by offloading the mechanical power required for oxygenation and ventilation by the lungs [164]. Peak inspiratory pressure should be maintained <25 cmH2O and minimizes FiO2 while maintaining 5–12 cmH2O of positive end expiratory pressure (PEEP) to prevent atelectasis [165]. For anticoagulation, heparin is most commonly used and recommended by ELSO [166]; however, use of bivalirudin has been found to be associated with reduced mortality in adult patients [167]. For hemodynamic management, these patients are usually vasoplegic due to both septic shock and VA-ECMO and need vasopressors such as norepinephrine, phenylephrine,


### **Table 4.**

*Pros and cons of using VA-ECMO in patients with septic cardiomyopathy.*

*Overview of Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support… DOI: http://dx.doi.org/10.5772/intechopen.105838*

vasopressin, and epinephrine to counteract vasoplegia. In case of suboptimal effect, agents such as methylene blue, hydroxycobalamin, and angiotensin II should be considered [168, 169].

**Pros and Cons of VA-ECMO in sepsis-induced cardiomyopathy:** While it has been established that ECMO is a viable option for management of SCM, **Table 4** presents the pros and cons of ECMO in patients with septic cardiomyopathy.
