**9.3 Role of ECMO in nonacute myocardial infarction cardiogenic shock**

Patients with acute heart failure (HF) who present in CS have high mortality. Conventional HF therapies including optimal medical management, inotropes, vasopressors, and IABP are the initial line of management. However, patients who fail to respond to medical management may benefit from VA-ECMO. It is indicated in patients with medically refractory CS and in patients at high risk of cardiogenic shock as determined by scoring systems such as CardShock risk score and IABP-SHOCK II risk scores. ECMO is also AMCS of choice in patients with CS who have biventricular failure, respiratory failure, life-threatening arrhythmias, or cardiac arrest. There is often an overlap between indications for ECMO and AMCS devices. However, patients with CS who have associated respiratory failure are best managed by ECMO [106, 107]. The outcome of ECMO in patients with HF varies significantly depending on the etiology. The survival after hospital discharge for patients managed with ECMO is 71.9% for myocarditis [108], 74.3% for patients with primary graft failure post-heart transplant [109], and 42% one-year survival for patients with acute decompensation of chronic cardiomyopathy. However, patients aged >75 years, patients with severe neurological injury, multiple organ failure, and multiple comorbidities are risk factors for adverse outcomes. Dangers et al. also reported poor outcomes of ECMO in patients with SOFA scores >13 prior to ECMO cannulation [110].

The role of ECMO in these patients varies depending upon the etiology and can be a bridge to recovery, bridge to transplant, bridge to left ventricular assist device (VAD), or bridge to decision [111].


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