Comprehensive Hemodynamic Characterization and Clinical Implications of Venoarterial Extracorporeal Membrane Oxygenation (ECMO) in Cardiopulmonary Support-Review for ICU Professionals

Alammar, Abdulrahman Nasser; Al Mutairi, Abdulelah Qalet; Al Mutairi, Mohammad Nasser; Al Harbi, Naif Abdulaziz; Alduhami, Abdulrahman Sulaiman; Al-Yahya, Saleh Abdulrahman Ali; Alhadlaq, Faisal Abdulaziz A; ALSAEED, SAUD HAMAD; Alkhudhaur, Abdulaziz Mohammed Abdullah; Albaqami, Faisal Abdullah Hader; Alharthi, Shaden Saad

doi:10.21608/jmals.2025.442788

Comprehensive Hemodynamic Characterization and Clinical Implications of Venoarterial Extracorporeal Membrane Oxygenation (ECMO) in Cardiopulmonary Support-Review for ICU Professionals

Document Type : Original Article

Authors

¹ Master Quality and Patient Safety Improvement, Northern Area Armed Forces Hospital, SA

² Health Services Administration, Northern Area Armed Forces Hospital, SA

³ Quality and Patient Safety department, Northern Area Armed Forces Hospital, SA

⁴ Health Information Management, Qassim Armed Forces Hospital, SA

⁵ Supply Department, Alkharj Armed Hospital, SA

10.21608/jmals.2025.442788

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with refractory cardiac or respiratory failure. Since its introduction in 1972, ECMO has undergone significant advancements in circuit design, oxygenator efficiency, and monitoring systems, improving its safety and efficacy. Aim: This article provides a comprehensive review of venoarterial ECMO (VA ECMO), focusing on its hemodynamic effects, clinical applications, complications, and emerging innovations. Methods: The discussion examines ECMO circuit components (centrifugal pumps, oxygenators, cannulas), mechanics of blood extraction and reinfusion, gas exchange, and temperature regulation. It also explores clinical indications, contraindications, hemodynamic management, and complications such as oxygenator thrombosis, differential hypoxemia, and limb ischemia. Results: VA ECMO effectively supports cardiopulmonary function in cardiogenic shock, cardiac arrest, and severe hypoxemia. However, complications like left ventricular distention and thromboembolism require vigilant monitoring. Weaning protocols emphasize echocardiographic assessment and gradual flow reduction. Emerging techniques, such as percutaneous ventricular assist devices (e.g., Impella) and ambulatory ECMO, enhance cardiac unloading and patient mobility.
Conclusion: VA ECMO is a critical tool in managing severe cardiopulmonary failure; however, its success depends on multidisciplinary coordination, precise anticoagulation, and effective complication management. Technological advancements continue to improve outcomes, making ECMO a bridge to recovery or further intervention.

Keywords