Peripheral VA-ECMO: from Evolving Indications to Perioperative Implications

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a form of extracorporeal circulation that provides cardiopulmonary support in cardiogenic shock unresponsive to conventional therapy. Historically, VA-ECMO was limited to the operating room and primarily used to manage postcardiotomy cardiogenic shock cases. However, with advances in ECMO technology and a better understanding of patient selection criteria, VA-ECMO has expanded its role as a temporary and adaptable intervention in cardiogenic shock of diverse etiologies. This review provides an updated overview of the indications for peripheral VA-ECMO, discussing how recent studies have enhanced our understanding of when VA-ECMO should be considered. In addition, we discuss the feasibility of surgery during VA-ECMO support to improve perioperative planning and tailored anesthetic strategies following ECMO-related physiologic and pharmacological changes.