Contents

#### **Preface XI**


Asim Al Balushi, Samara Zavalkoff and Pia Wintermark

Chapter 6 **Percutaneous Mechanical Circulatory Support Devices: Systems and Clinical Options 77** Antonio Loforte, Giuditta Coppola, Carlo Mariani, Gregorio Gliozzi, Francesco Grigioni and Giuseppe Marinelli


Preface

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), has evolved to be a mainstream therapy for those requiring cardiac and/or pulmo‐ nary support for acute heart, lung, or heart and lung failure and who are failing convention medical therapies. With now thousands of cases being performed each year worldwide, it is rapidly evolving into a valuable tool in the management of critically ill patients. However, there is still much to be learned from a technology that is controversial, invasive, often cost‐ ly, and limited by a lack of convincing randomized trials. As experiences continue to grow, the hope is that outcomes will improve with better patient selection, better technologies, bet‐ ter guidelines and protocols for management, and a general understanding of the impor‐ tance of a team-based approach to managing extremely complex and sick patients. Critical to the success of ECMO therapy is the recognition that therapy must be initiated early before the onset of multiorgan dysfunction, neurologic complications, and the pathophysiologic consequences of irreversible shock. While veno-venous ECMO is often considered for pul‐ monary support and venoarterial for cardiac or cardiopulmonary support, the overlap in the management of acute heart and lung injuries can complicate decision making regarding the specific details of initiating therapy. Hopefully, the goal of this text—the second edition on the topic—is to lend further insights into some of the challenges that face providers, at all

This text is separated into several different areas—each focused on different aspects—of the management of patients who require extracorporeal support. While there are several chap‐ ters on general indications for ECMO—such as for respiratory failure, cardiogenic shock, and postcardiotomy shock—there are several chapters that focus on specific applications. These specific indications include, for example, the use of ECMO for high-risk catheterbased interventions, complications following heart transplant, and unusual applications in the neonate/newborn. Several chapters also focus on challenging topics regarding the use of ECMO and include advanced concepts such as flow optimization, pump circuit design, and the relationship to ventricular assist devices. An important topic that is also addressed is the role of simulation training as a critical component to the development and maintenance of

A theme common to many of the chapters is the importance of team communication with the focus on optimizing timely care for critically ill patients. Without doubt, the importance of early initiation of therapy prior to the sequelae of shock, hypoxemia, and hypotension resulting in end-organ damage and neurologic dysfunction cannot be overemphasized. Fur‐ thermore, once the decision is made to support a patient on ECMO, a primary goal is to allow the heart and/or lungs to rest and recover. Prevention of complications while on EC‐ MO is also paramount to good outcomes and is discussed in many of the chapters that focus

levels, who are interested in ECMO or use it routinely

competency of a high-quality ECMO program.

on specific applications of ECMO.

