Over the past decade, the use of extracorporeal membrane oxygenation (ECMO) has increased exponentially, from approximately 30–40 patients per year in the United States 20 years ago, to over 2,000 per year currently, and rising.¹ The increased utilization of ECMO has resulted from improved cannulation techniques, including percutaneous approach, as well as advances in the technology of the pumps, oxygenators, and cannulas. Despite these features, however, choosing appropriate candidates and managing their daily care can be extremely challenging. What follows is an in-depth discussion of the indications for venoarterial (VA) ECMO in adult patients affected by cardiac disease, the manner of its application, the physiology underlying the care for these patients, and the assessment and treatment of complications, including ethical and organizational issues.

More in-depth material and information are provided in the Extracorporeal Life Support Organization (ELSO) 5th Edition Red Book.² Furthermore, the recent ELSO indications about ECLS and cannulation nomenclature will be followed in this guideline.