Venoarterial

Venoarterial refers to a form of circulatory or extracorporeal support in which blood is drained from the venous system, circulated through an external device for oxygenation and/or pumping, and returned to the arterial circulation. In clinical practice, the term is most often associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), a support modality that provides both cardiac and respiratory support.

In VA-ECMO, deoxygenated blood is typically drained from a central venous or peripheral venous site and routed through an oxygenator and pump before being returned to an arterial site. Common configurations use a femoral vein for drainage and a femoral or axillary artery for return, though central cannulation via sternotomy may be used in perioperative settings or neonates. Peripheral VA-ECMO can affect afterload and may require strategies to unload the left ventricle.

Indications include refractory cardiogenic shock, cardiopulmonary failure due to massive myocardial infarction, fulminant myocarditis, post-cardiotomy failure, and extracorporeal resuscitation (E-CPR) during cardiac arrest.

Management issues involve systemic anticoagulation to prevent circuit thrombosis, vigilant monitoring of perfusion and oxygenation, and assessment for complications such as bleeding, thromboembolism, limb ischemia, infection, hemolysis, and neurologic injury. Left ventricular unloading or adjunctive measures may be employed to reduce distension and pulmonary edema.

VA-ECMO is typically considered a bridge to recovery, durable ventricular assist devices, or heart transplantation, depending on the underlying condition and the patient’s recovery trajectory. It is distinct from venovenous ECMO, which provides primarily respiratory support without direct circulatory assistance.