Dynamic and Hybrid Extracorporeal Membrane Oxygenation Configurations Require Greater Involvement of Vascular Surgeons

The use of extracorporeal membrane oxygenation (ECMO) for adult patients with refractory cardiac, pulmonary, or cardiopulmonary shock has increased dramatically in the past decades. A substantial and understudied subset of these patients will require reconfiguration of their ECMO circuit. The indications for reconfiguration include escalation or de-escalation of arterial support for changes in native cardiac output, anatomic considerations for limb compromise or thrombus formation, and transition to long-term support involving ventricular-assist devices.