Complications of ECMO and IABP

Introduction

Intra-arterial devices used to assist in the management of critically ill patients with cardiopulmonary failure have become commonplace at most advanced medical centers in the past decade. Extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumps (IABP) are two of the most commonly utilized percutaneous strategies. Temporary use of inotropic medications and IABP is successful in weaning the majority of patients from cardiopulmonary support; however, a small fraction are refractory. Similarly, only a small minority of patients with acute respiratory distress syndrome (ARDS) will not respond favorably to conventional treatment modalities (mechanical ventilation, permissive hypercapnia, positional maneuvers) and will need to go on to increased cardiopulmonary support provided by ECMO. Because these devices are often inserted from a transfemoral approach, understanding the indications, techniques, and complications that can arise from use of these devices is important for the vascular surgeon who is often called upon to manage the immediate and long-term problems that arise.