Advanced cardiac surgery without ECMO

Abstract

While there has been a significant increase in the utilization of extra-corporeal membrane oxygenation worldwide, it is still important to remember that it remainds a resource that is limited in availabilty due to costs and need for extensive resources. As such, there are concerns and issues that surround the need for being able to perform highrisk cardiac surgery without the availability of ECMO, even if there might be patients who could benefit from this technology. Furthermore, understanding how to avoid ECMO in the cardiac surgery patient might provide some insights to those who have access to ECMO, but are concerned about escalation of therapy. Is cardiac surgery possible without ECMO in high-risk patients? Would high-risk patients, particularly, benefit from cardiac surgery? Is cardiac surgery advantageous in patients with a low left ventricular ejection fraction (LVEF)? Undoubtedly, a discussion over the second question reveals significant improvements in the survival of patients amenable to cardiac surgery. Part of the question is understanding what types of interventions would be possible when ECMO is not available. © 2021 Elsevier B.V., All rights reserved.