ExtraCorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock

Inclusion Criteria: Patients must fulfil criteria for rapidly deteriorating (A) or severe (B) cardiogenic shock: A. Rapidly deteriorating cardiogenic shock is defined as progressive hemodynamic instability necessitating repeated bolus administration of vasopressors to maintain mean arterial pressure \> 50 mmHg + impaired left ventricle systolic function (Left ventricle ejection fraction (LVEF) \< 35% or LVEF 35-55% in case of severe mitral regurgitation or aortic stenosis) or B. In severe cardiogenic shock all following criteria should be met: 1. Hemodynamic: Cardiac Index (CI) \< 2.2 L/min/m2 + norepinephrine dose \> 0.1 μg/kg/min + dobutamin dose \> 5 μg/kg/min or Systolic blood pressure \< 100 mmHg + norepinephrine dose \> 0.2 μg/kg/min + dobutamin dose \> 5 μg/kg/min + (LVEF \< 35% or LVEF 35-55% + severe mitral regurgitation or aortic stenosis) 2. Metabolic: Lactate - two consecutive values ≥ 3 mmol/L (with at least 30 min between samples), with non-decreasing trend on steady doses of inotropes and/or vasopressors or SvO2 - two consecutive values \< 50% (with at least 30 min between measurements), with non-increasing trend on steady doses of inotropes and/or vasopressors 3. Hypovolemia must be excluded: Central venous pressure \> 7 mmHg or pulmonary capillary wedge pressure \> 12 mmHg Exclusion Criteria: 1. Age \< 18 years 2. Life expectancy lower than 1 year 3. High suspicion of pulmonary emboli or cardiac tamponade as a cause of shock 4. Significant bradycardia or tachycardia which might be responsible for hemodynamic instability and not treated by pacing or cardioversion 5. Cardiac arrest survivors remaining comatose 6. Hypertrophic obstructive cardiomyopathy 7. Peripheral artery disease disabling insertion of outflow cannula to femoral artery 8. Moderate to severe aortic regurgitation 9. Aortic dissection 10. Uncontrolled bleeding or TIMI major bleeding within last 6 months 11. Known encephalopathy