The Role of Venoarterial ECMO in the Management of Sepsis-Induced Cardiomyopathy and Refractory Shock: An Analytic Review

Sepsis-induced cardiomyopathy is a severe complication seen in patients with refractory septic shock, characterized by cardiac dysfunction due to an overwhelming inflammatory response secondary to infection. Despite its reversible nature, sepsis-induced cardiomyopathy (SIC) can significantly increase mortality in septic shock patients despite treating the underlying infection. Prompt recognition and aggressive intervention can potentially support the recovery of cellular injuries caused by inflammation and improve outcomes. Recently, venoarterial-extracorporeal membrane oxygenation (VA-ECMO) has gained attention as a potential mechanical support for managing these patients with SIC and cardiogenic shock. However, the lack of consensus in defining SIC and the variation in inclusion criteria for VA-ECMO implementation in acute sepsis-induced cardiogenic shock made it challenging to interpret the results of related studies. A more specific definition of SIC and careful selection of patients who may benefit from ECMO support could improve outcomes in this population. This analytic review discusses the mechanisms leading to cardiomyocyte injury and SIC, and summarizes recent studies including the efficacy of VA-ECMO in managing refractory septic shock due to SIC.