Darryl Abrams Alain Combes Daniel Brodie What’s new in extracorporeal membrane oxygenation for cardiac failure and cardiac arrest in adults? Received: 14 December 2013 Accepted: 6 January 2014 Published online: 29 January 2014 Ó Springer-Verlag Berlin Heidelberg and ESICM 2014 D. Abrams Á D. Brodie ( ) ) Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 W. 168th St, PH 8E 101, New York, NY 10032, USA e-mail: hdb5@columbia.edu Tel.: ?1-212-3059817 Fax: ?1-212-3058464 D. Abrams e-mail: da2256@columbia.edu A. Combes Service de Re ´animation Me ´dicale, Groupe Hospitalier Pitie ´- Salpe ˆtrie `re, Institute of Cardiometabolism and Nutrition (iCAN), Assistance Publique-Ho ˆpitaux de Paris, Universite ´ Pierre et Marie Curie, Paris 6, France Introduction Extracorporeal membrane oxygenation (ECMO) is one of several mechanical circulatory support devices used for patients with cardiac failure (Fig. 1). Advances in both extracorporeal technology and cannulation techniques, which have led to an improved risk–benefit profile, have increased the use and broadened the potential applications for ECMO in these circumstances. Additional data is ultimately needed to select the most appropriate patients and circumstances for extracorporeal support [1]. Myocardial infarction-associated cardiogenic shock Recent non-randomized studies suggest a survival advantage from the early use of ECMO in cardiogenic shock complicating acute myocardial infarction (Table 1). An observational study comparing patients with ST-seg- ment elevation myocardial infarction-related cardiogenic shock undergoing percutaneous coronary intervention (PCI), before and after the availability of ECMO, revealed a significantly lower 30-day mortality among the ECMO recipients (39.1 vs. 72 %, p = 0.008) [2]. Interpretation of this data is limited by the comparison of groups over two consecutive time periods, with discrepancies in both medical and interventional management over time. Fulminant myocarditis Patients with cardiogenic shock from non-ischemic etiolo- gies, including fulminant myocarditis, may likewise benefit from ECMO support. In a cohort of patients who received either a biventricular assist device (n = 6) or ECMO (n = 35) for fulminant myocarditis with refractory cardio- genic shock, intensive care unit (ICU) survival was 68 % [3]. Among a subset with long-term follow-up, health-related quality of life scores were lower than matched controls but comparable to other subjects who had received ventricular assist devices (VADs) as bridge to heart transplantation. ECMO may be as effective in supporting fulminant myo- carditis as a VAD. In a cohort of 11 patients supported with either ECMO or a biventricular assist device, there was no significant difference in survival to discharge without transplantation (83 vs. 80 %). Those receiving ECMO had more rapid renal and hepatic recovery, despite a higher severity of illness prior to device implantation [4]. Sepsis-associated cardiomyopathy Profound myocardial depression is a well-recognized consequence of severe septic shock. Emerging data Intensive Care Med (2014) 40:609–612 DOI 10.1007/s00134-014-3212-0 WHAT’S NEW IN INTENSIVE CARE