This study states that Cardiogenic shock (CS) is most commonly caused by acute myocardial infarction, accounting for 80% of cases.1 Despite improvements in revascularization and systems of care, mortality rates are still more than 30% in contemporary studies.2–4 Hence, for critically ill patients with CS who do not respond to (or who deteriorate with) initial medical therapy and supportive measures, temporary mechanical circulatory support has emerged as a promising measure to interrupt the downward spiral of hypotension and end-organ hypoperfusion that may portend cardiac death.5,6 Among the temporary mechanical circulatory support options available, venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides robust biventricular and respiratory support and may be the preferred option in patients requiring cardiopulmonary resuscitation, those with poor oxygenation that is not expected to improve with other devices, and those requiring biventricular support.6 One of the recognized complications of peripheral femoral VA-ECMO cannulation is the retrograde aortic perfusion of the heart. In some patients, the resultant increase in left ventricular (LV) afterload may impair LV ejection, raise the LV end-diastolic pressure, and potentially lead to North-South (or Harlequin) syndrome wherein pulmonary edema impairs gas exchange and deoxygenated blood enters the aorta leading to further coronary or cerebral ischemia.
Reference link- https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.050847
