Question 19

With regards to veno-arterial extra-corporeal membrane oxygenation (VA-ECMO):

a)    List six major conditions for which VA-ECMO is indicated.    (40% marks)

b)    List four contraindications for VA-ECMO.    (40% marks)

c)    List four life threatening complications of VA-ECMO.    (20% marks)

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College answer

Not available.


This weird question asked for lists, which means that it would have been theoretically possible to score full marks with fourteen lines of text.

a) Six major conditions for which VA-ECMO is indicated:

  • Failure to wean from cardiopulmonary bypass
  • Cardiogenic shock of any cause
  • Cardiac arrest from a reversible cause (i.e. ECPR)
  • Bridge to cardiac transplant or LVAD
  • Graft failure following cardiac transplantation
  • Perioperative support for surgery requiring cardiac arrest or cardiopulmonary bypass

b) Four contraindications for VA ECMO:

  • Contraindications to anticoagulation: recent surgery, uncontrolled bleeding, intracranial haemorrhage, DIC (eg. sepsis, Ebola)
  • Irreversible condition
  • Contraindications for heart/lung transplant
  • Major immunosuppression (eg. bone marrow transplant)

c) Four life-threatening complications for VA ECMO:

  • LV distension and pulmonary haemorrhage (with VA ECMO)
  • Cardiac chamber thrombosis (with VA ECMO)
  • Bleeding complications (eg. intracranial haemorrhage)
  • Embolic phenomena (air bubbles,  clots)


All, literally all of this comes from the ELSO documentation.

Specifically, the ELSO Guidelines General v1.4 were of the greatest use.