Monitoring of the Adult Patient on Venoarterial Extracorporeal Membrane Oxygenation

Figure 1

VA ECMO support after cardiac arrest provides hemodynamic stabilization, which allows time for therapeutic hypothermia and assessment of the neurologic status of the patient. If the patient achieves both neurologic and cardiac recovery, VA ECMO support will have functioned as a bridge to recovery and can subsequently be removed. If the patient does not recover neurologic function, VA ECMO support is typically withdrawn. If the patient awakens but does not have recoverable myocardial function, candidacy for heart transplant (bridge to transplant) and temporary (bridge to a bridge) or permanent (destination therapy) implantation of a ventricular assist device can be assessed. The neurologically intact patient that is disqualified from a heart transplant or ventricular assist device presents a dilemma that may be described as a bridge to nowhere. Figure adapted from [1].