Although mechanical circulatory support (MCS) has been used to support patients with cardiogenic shock (CS) for many years, recent advances in device technology, together with the lackluster performance of isolated pharmacological therapy, have increased its utilization in this setting.

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has been increasingly implemented, particularly in patients with postcardiotomy CS or cardiac arrest, because V-A ECMO has several advantages over other MCS modalities. Advantages of V-A ECMO include rapid deployment, biventricular support, gas exchange provisions, peripheral and percutaneous approaches for insertion, the ability to provide support for days or weeks, relatively inexpensive disposables for the equipment, and widespread availability with well established programs at most major centers.

However, despite the established benefits of V-A ECMO, several shortcomings of this technology persist and remain a matter of thorough debate.