3 ms·

Thank you for this reply. Highly informative. > whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO dis

Thank you for this reply. Highly informative. > whereas I think that patient risk + superior bridging/destination strategies really do dominate the VA ECMO discussion. Is the idea here that when doctors are considering VA ECMO for a patient there is usually some non-trivial chance that the patient survives without it? In that case the choice, I guess, is between higher survival with more complications (VV ECMO) and lower survival with fewer complications (no ECMO)?

carbocation 5y ago
Sort of a facile response but we'll at least consider VA ECMO if we think the benefits outweigh the risks. E.g., a person in worsening cardiogenic shock because of a usually reversible insult (e.g., severe stress cardiomyopathy, or a refractory ventricular arrhythmia) has a very good chance of surviving the acute hospitalization but if I'm worried they will die tonight (even if they'd be fine 2 days from now after some recovery time) then will discuss VA ECMO with the people who actually do it for a living. VA ECMO's complications are a consideration in that calculus. That's the kind of decision where I think an observer could argue (especially if things go well) that there was a non-trivial chance that the patient would have survived without ECMO.