**9.9 Improved outcome of patients with sepsis-induced cardiomyopathy and use of ECMO**

While the management of SIC has been previously limited to vasopressors, inotropes, and fluid management, the use of ECMO has recently been explored. A low cardiac output due to SIC can impair the organ perfusion and precipitate multi-organ failure. Thus, it appears reasonable to identify and restore the cardiac output in these patients. Patients deteriorating despite maximal pharmacological support should be promptly transitioned to acute mechanical circulatory support (AMCS) device including VA-ECMO. Studies have found that VA-ECMO significantly improves the survival in patients with SIC with LV dysfunction compared to patients with preserved LV function [153, 154].

An important multicenter retrospective study performed by Bréchot et al. and published in 2020 investigated the role of VA-ECMO in patients with SIC. In this study, 82 patients with a sepsis-induced refractory shock treated with VA-ECMO were compared to 130 patients treated with conventional therapy for 90 days. Despite a propensity-weighted analysis, survival in the treatment group was higher than that in the control group (51% vs. 14%, relative risk for mortality 0.57, p = 0.003). The study also concluded that survival with VA-ECMO was better in younger patients and

the strong initial protective effect of VA-ECMO waned over time [(0 to 7 days: HR 0.14; 95% CI: 0.05 to 0.41) vs. (7 to 14 days: HR 0.79; 95% CI: 0.13 to 4.64)] [155]. The findings of the study emphasized that patients with SIC should be identified and supported with VA-ECMO as early as possible.
