Candidates and allocation time for extracorporeal membrane oxygenation in patients with cardiogenic shock

Abstract Extracorporeal membrane oxygenation (ECMO) is a last resort life support in several patients with cardiogenic shock. However, appropriate candidates and optimal timing of ECMO initiation need to be established. The present report reviewed relevant literatures to refine the allocation of ECMO in patients with cardiogenic shock. The PubMed database was searched from inception to October 5, 2020, using the following search terms: “extracorporeal membrane oxygenation” or “mechanical circulatory support” AND “cardiogenic shock” or “cardiac arrest” or “myocardial infarction” or “fulminant myocarditis.” The etiology of cardiogenic shock, widened QRS duration, QTc interval prolongation, cardiac arrest, dynamic narrowing of pulse pressure, and speed of lactate accumulation per unit time can be associated with the course of cardiogenic shock, and typically warn that advanced medical circulatory support is required. In the critical moment when the circulatory status deteriorates sharply, an immediate physical examination combined with ready-to-use tools such as monitoring data or blood gas analysis results is crucial for assessing the appropriateness and timing of ECMO initiation.