[dr_coffee]

One important distinction is to understand that VA ECMO is more often used as mechanical circulatory support in cases of severe heart failure leading to cardiogenic shock. Used alone or in conjunction with other mechanical devices (balloon pumps or impella pumps) it can augment cardiac output to provide sufficient perfusion and oxygenation of your organs and distal extremities.

VV ECMO, on the other hand, is used purely for gas exchange (O2 and CO2) due to respiratory failure. Much of the debate in the critical care community is centered around which circumstances and patients derive the most benefit from initiation of VV ECMO. The best studied use case, is in the setting of acute respiratory distress syndrome, which is defined by very specific criteria (bilateral noncardiogenic pulmonary edema with ratio of arterial oxygenation partial pressure to fraction of inspired oxygen less than 300 mmHg). The EOLIA trial published in NEJM in 2018 looked at early initiation of VV ECMO in patients with severe ARDS [1]. It demonstrated no mortality benefit of ECMO, however many say that the study was not appropriately powered as the assumptions used to design the study were from 2008 when mortality from ARDS was much higher. Re-analysis of the data from the EOLIA trial using bayesian methods suggests that there might actually some benefit to early initiation of ECMO [2]

1. https://www.wikijournalclub.org/wiki/EOLIA

2. https://jamanetwork.com/journals/jama/fullarticle/2709620