Table 3 Advanced extracorporeal life support strategies for cardiac and respiratory support: bridging to intermediate or long-term support may be required

VA ECMO (return femoral artery)

Default strategy for potentially reversible cardiogenic shock of any cause

VA ECMO (return axillary artery)

Reversible cardiogenic shock where high flows are not required

Reversible cardiogenic shock with lower-limb vascular disease

Reversible cardiogenic shock with poor gas exchange

VA ECMO (return ascending aorta)

Failure to wean from cardiopulmonary bypass where recovery expected within 7 days

Salvage for small patients with cardiogenic shock where femoral arterial access inadequate

Salvage for severe combined cardiac and respiratory failure

VA–venous ECMO

Patients developing circulatory instability on venovenous ECMO

Salvage for severe combined cardiac and respiratory failure

Venous–pulmonary artery ECMO

Reversible RV dysfunction expected duration up to 2 weeks

Centrimag™ (Levitronix LLC, Waltham, MA, USA) RVAD (femoral access + oxygenator)

Reversible RV dysfunction expected duration up to 2 weeks

Centrimag™ (Levitronix LLC) RVAD (right atrium access + oxygenator)

Reversible isolated RV dysfunction expected duration up to 8 weeks with plan to remove oxygenator and convert to RVAD

Centrimag™ (Levitronix LLC) hybrid (requires oxygenator)

Severe LV after load mismatch on VA ECMO

Severe combined cardiac and respiratory failure where early RV recovery is expected before intermediate term LV recovery

Implantable LVAD + temporary RVAD (±oxygenator)

Met criteria for LVAD but unexpected reversible RV dysfunction occurred