Extra Corporeal Membrane Oxygenation (ECMO) in Acute Coronary Syndrome

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an established strategy for cardiopulmonary support with increasing use in patients with cardiovascular collapse.Now it is used in many conditions such as Post-cardiotomy and primary graft failure after heart transplant, bridge to heart transplant , Severe cardiac failure , Cardiac Shock persists to conventional therapy , CPR and some other conditions.Acute coronary syndrome (ACS) complicated by shock is associated with high mortality despite the use of percutaneous support devices. ECMO offers cardiopulmonary support but its safety and efficacy in the ACS setting is still under investigation.Cardiogenic shock is an acute emergency, which is classically managed by medical support with inotropes or vasopressors. However, catecholamines are associated with a worse prognosis, and many patients deteriorate despite all efforts. Mechanical circulatory support is increasingly considered to allow for recovery or be a bridge until making a decision or definite treatment. Intra Aortic Baloon Pupm(IABP) can be helpful, but nowadays ECMO is widely used.In patients with severe shock or refractory ventricular arrhythmias due toACS, VA‐ECMO likely offers an alternative form of biventricular support so there will be time to recovery or other therapies.Patients who sustain refractory in-hospital cardiac arrest (IHCA) with severe cardiopulmonary compromise in the cardiac catheterization laboratory have an extremely low survival. Despite early revascularization to infarct-related coronary artery, mortality rates vary between 80-90%.VA-ECMO can be lifesaving and is increasingly used in patients with reversible conditions who sustain refractory cardiac arrest or profound cardiogenic shock.VA-ECMO has also been used during primary PCI in patient’s whit ST-elevation myocardial infarction and survival rate and neurological outcome has reported good, even when the patient is admitted with a cardiac arrest.It seems that ECMO can be life-saving in these situations when no other forms of treatment are likely to be successful but more researches are needed to be carried out in the future.