To vent or not on veno-arterial extracorporeal membrane oxygenation, does it improve myocardial recovery and outcome?

Worldwide the utilization of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) increased dramatically over the last decade, but mortality for cardiogenic shock did not significantly change and is still ranging between 50–70% (Figure 1) (5,6). Early revascularization has been shown to improve outcome in shock patients (SHOCK trial) (1). Likewise, a marked survival benefit has been documented for VA ECMO assisted resuscitation (ECPR) (7,8). However, with regard to ECMO therapy beyond CPR many questions aiming at optimization of outcome results remain unanswered so far. One of these ongoing controversies is the need of a vent during ECMO support.