Profound hypotension, ongoing CS despite optimal medical treatment, escalating vasopressor requirements, rapidly deteriorating cardiac function, worsening lactic acidosis, and signs of end-organ hypoperfusion are the main clinical clues that MCS is required in CS. The ECMO-CS trial characterized rapidly deteriorating cardiogenic shock as a progressive hemodynamic instability necessitating repeated vasopressor boluses to maintain a mean arterial pressure greater than 50 mm Hg, together with

Risk stratification tools have been developed to predict survival following VA-ECMO and to assist with optimal patient selection. The Survival After Veno-Arterial ECMO (SAVE) score is a weighted prognostic model designed to estimate in-hospital survival in adults with refractory CS supported by VA-ECMO. The SAVE score integrates multiple pre-ECMO variables across several domains, including the etiology of cardiogenic shock, age, body weight, and acute pre-ECMO organ dysfunction involving the

VA-ECMO delivers circulatory and respiratory support by diverting venous blood for oxygenation and removal of carbon dioxide and returning it to the arterial circulation. Cannulation can be performed using either peripheral or central approaches, each with distinct technical considerations, physiologic effects, risks, and clinical indications. Peripheral VA-ECMO is most commonly performed via the femoral vessels, with venous drainage through the femoral vein (advancing the cannula to the