Table 3.

Advanced extracorporeal life support strategies for cardiac and respiratory support: bridging to intermediate or long-term support may be required

ECLS strategy	Principle indication(s)
VA ECMO (return femoral artery)	Default strategy for potentially reversible cardiogenic shock of any cause
VA ECMO (return axillary artery)	Reversible cardiogenic shock where high flows are not required
	Reversible cardiogenic shock with lower-limb vascular disease
	Reversible cardiogenic shock with poor gas exchange
VA ECMO (return ascending aorta)	Failure to wean from cardiopulmonary bypass where recovery expected within 7 days
	Salvage for small patients with cardiogenic shock where femoral arterial access inadequate
	Salvage for severe combined cardiac and respiratory failure
VA–venous ECMO	Patients developing circulatory instability on venovenous ECMO
	Salvage for severe combined cardiac and respiratory failure
Venous–pulmonary artery ECMO	Reversible RV dysfunction expected duration up to 2 weeks
Centrimag™ (Levitronix LLC, Waltham, MA, USA) RVAD (femoral access + oxygenator)	Reversible RV dysfunction expected duration up to 2 weeks
Centrimag™ (Levitronix LLC) RVAD (right atrium access + oxygenator)	Reversible isolated RV dysfunction expected duration up to 8 weeks with plan to remove oxygenator and convert to RVAD
Centrimag™ (Levitronix LLC) hybrid (requires oxygenator)	Severe LV after load mismatch on VA ECMO
	Severe combined cardiac and respiratory failure where early RV recovery is expected before intermediate term LV recovery
Implantable LVAD + temporary RVAD (±oxygenator)	Met criteria for LVAD but unexpected reversible RV dysfunction occurred

ECLS, extracorporeal life support; ECMO, extracorporeal membrane oxygenation; LV, left ventricular; LVAD, left ventricular assist device; RV, right ventricular; RVAD, right ventricular assist device; VA, venoarterial.