Table 2 Extracorporeal life support strategies for mechanical circulatory support in isolated cardiac failure
ECLS strategy | Principle indication(s) |
|---|---|
VA ECMO (return femoral artery) | Default strategy for potentially reversible cardiogenic shock of any cause |
Central VA ECMO (return aorta) | Failure to wean from cardiopulmonary bypass where recovery expected within 7Â days |
| Â | Salvage for small patients with cardiogenic shock where femoral arterial access inadequate |
VA ECMO (return axillary artery) | Reversible cardiogenic shock where high flows not required |
| Â | Reversible cardiogenic shock with lower-limb vascular disease |
Centrimagâ„¢ (Levitronix LLC, Waltham, MA, USA) LVAD (access left atrium/left ventricle, return aorta) | Isolated LV support where recovery is expected in 8Â weeks |
Centrimagâ„¢ (Levitronix LLC) RVAD (access right atrium, return pulmonary artery) | Isolated RV support where recovery is expected in 8Â weeks |
Centrimagâ„¢ (Levitronix LLC) BiVAD | Biventricular support where recovery is expected in 8Â weeks |
TandemHeart (CardiacAssist, Inc., Pittsburgh, PA, USA) percutaneous LVAD (access left atrium via femoral vein, return femoral artery | Isolated LV support |
Impellaâ„¢ (Abiomed, Aachen, Germany) percutaneous LVAD (access femoral artery) | Isolated LV support |
Peripheral VA ECMO + Impella™ (Abiomed) percutaneous LVAD | Isolated LV support with better LV decompression |
Implantable LVAD + temporary RVAD (±oxygenator) | Met criteria for LVAD but unexpected reversible RV dysfunction occurred |