{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:15:32Z","timestamp":1788779732856,"version":"build-2803163510"},"reference-count":128,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Septic shock remains a major cause of mortality in critical care, driven by profound vasoplegia, myocardial depression and refractory circulatory collapse. Conventional therapy occasionally fails to restore adequate perfusion, leading to life-threatening multi-organ failure. Methods: This narrative review examines current evidence on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a salvage strategy for refractory septic shock, focusing on the pathophysiological rationale, patient selection, timing of initiation and hemodynamic management. Results: Data from observational studies and registry analyses suggest that V-A ECMO may improve survival in patients with septic cardiomyopathy (SCM), with reported survival rates approaching 40% in selected adult cohorts and over 50% in pediatric populations. Early initiation, phenotype-guided selection and precise hemodynamic titration are critical to optimize outcomes. Conclusions: The role of ECMO in septic shock remains controversial and should be restricted to experienced centers and well-defined phenotypes. Future research must refine selection criteria, standardize support strategies and evaluate long-term functional recovery beyond survival.<\/jats:p>","DOI":"10.3390\/jcm14227904","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:55:15Z","timestamp":1762527315000},"page":"7904","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["ECMO in Refractory Septic Shock: Patient Selection, Timing and Hemodynamic Targets"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5046-4275","authenticated-orcid":false,"given":"Debora Emanuela","family":"Torre","sequence":"first","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care Unit, Cardiac Surgery, Ospedale dell\u2019Angelo, Mestre, 30174 Venice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1007\/s00134-020-06151-x","article-title":"Incidence and mortality of hospital- and ICU-treated sepsis: Results from an updated and expanded systematic review and meta-analysis","volume":"46","author":"Mellhammar","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s00134-019-05878-6","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"46","author":"Weiss","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.jointm.2023.07.001","article-title":"Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom","volume":"4","author":"Zhang","year":"2023","journal-title":"J. Intensive Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/MAT.0000000000001510","article-title":"ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients","volume":"67","author":"Lorusso","year":"2021","journal-title":"ASAIO J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/MAT.0000000000001432","article-title":"Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)","volume":"67","author":"Tonna","year":"2021","journal-title":"ASAIO J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23","DOI":"10.31083\/j.rcm2501023","article-title":"Septic Cardiomyopathy","volume":"25","author":"Zibar","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/s13054-021-03668-5","article-title":"Venoarterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: A systematic review and meta-analysis with individual participant data meta-regression analysis","volume":"25","author":"Ling","year":"2021","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yang, Y., Xiao, Z., Huang, J., Gong, L., and Lu, X. (2022). Role of Extracorporeal Membrane Oxygenation in Adults and Children With Refractory Septic Shock: A Systematic Review and Meta-Analysis. Front. Pediatr., 9.","DOI":"10.3389\/fped.2021.791781"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/MAT.0000000000001464","article-title":"Extracorporeal Membrane Oxygenation for Septic Shock in Children","volume":"68","author":"Melnikov","year":"2022","journal-title":"ASAIO J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MAT.0000000000000934","article-title":"A Systematic Review of Preexisting Sepsis and Extracorporeal Membrane Oxygenation","volume":"66","author":"Sangli","year":"2020","journal-title":"ASAIO J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1186\/s13054-018-2102-1","article-title":"Definitions and pathophysiology of vasoplegic shock","volume":"22","author":"Lambden","year":"2018","journal-title":"Crit. Care"},{"key":"ref_13","first-page":"56","article-title":"Vasoplegia in septic shock (review)","volume":"239","author":"Gamcrlidze","year":"2015","journal-title":"Georgian Med. News."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1007\/s00134-010-2045-8","article-title":"Vascular hyporesponsiveness to vasopressors in septic shock: From bench to bedside","volume":"36","author":"Levy","year":"2010","journal-title":"Intensive Care Med."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Sullivan, R.C., Rockstrom, M.D., Schmidt, E.P., and Hippensteel, J.A. (2021). Endothelial glycocalyx degradation during sepsis: Causes and consequences. Matrix Biol. Plus., 12.","DOI":"10.1016\/j.mbplus.2021.100094"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"16045","DOI":"10.1038\/nrdp.2016.45","article-title":"Sepsis and septic shock","volume":"2","author":"Hotchkiss","year":"2016","journal-title":"Nat. Rev. Dis. Primers."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1186\/s13613-018-0402-x","article-title":"Principles of fluid management and stewardship in septic shock: It is time to consider the four D\u2019s and the four phases of fluid therapy","volume":"8","author":"Malbrain","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Carbone, F., Liberale, L., Preda, A., Schindler, T.H., and Montecucco, F. (2022). Septic Cardiomyopathy: From Pathophysiology to the Clinical Setting. Cells, 11.","DOI":"10.3390\/cells11182833"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1177\/08850666231180526","article-title":"Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis","volume":"38","author":"Hasegawa","year":"2023","journal-title":"J. Intensive Care Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.medin.2017.10.004","article-title":"Management of myocardial dysfunction in septic shock. Potential role of extracorporeal membrane oxygenation","volume":"42","author":"Riera","year":"2018","journal-title":"Med. Intensiv."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40560-016-0148-1","article-title":"Sepsis-induced myocardial dysfunction: Pathophysiology and management","volume":"4","author":"Kakihana","year":"2016","journal-title":"J. Intensive Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1186\/cc1822","article-title":"Clinical review: Myocardial depression in sepsis and septic shock","volume":"6","author":"Court","year":"2002","journal-title":"Crit. Care"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Liu, Y.C., Yu, M.M., Shou, S.T., and Chai, Y.F. (2017). Sepsis-Induced Cardiomyopathy: Mechanisms and Treatments. Front. Immunol., 8.","DOI":"10.3389\/fimmu.2017.01021"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1097\/01.CCM.0000266683.64081.02","article-title":"Mechanisms of sepsis-induced cardiac dysfunction","volume":"35","author":"Rudiger","year":"2007","journal-title":"Crit. Care Med."},{"key":"ref_25","first-page":"e202030","article-title":"The coronary microcirculation in sepsis: Not of micro-importance","volume":"2020","author":"Olivotto","year":"2020","journal-title":"Glob. Cardiol. Sci. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4266\/acc.2020.00248","article-title":"Sepsis-induced cardiac dysfunction: A review of pathophysiology","volume":"35","author":"Habimana","year":"2020","journal-title":"Acute Crit. Care"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Demailly, Z., Besnier, E., Tamion, F., and Lesur, O. (2023). Ventriculo-arterial (un)coupling in septic shock: Impact of current and upcoming hemodynamic drugs. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1172703"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1186\/s40560-015-0112-5","article-title":"A review of sepsis-induced cardiomyopathy","volume":"3","author":"Sato","year":"2015","journal-title":"J. Intensive Care"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5492\/wjccm.v12.i3.139","article-title":"Sepsis-induced mitochondrial dysfunction: A narrative review","volume":"12","author":"Nedel","year":"2023","journal-title":"World J. Crit. Care Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1111\/aas.12581","article-title":"Microcirculatory dysfunction and tissue oxygenation in critical illness","volume":"59","author":"Granfeldt","year":"2015","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Raia, L., and Zafrani, L. (2022). Endothelial Activation and Microcirculatory Disorders in Sepsis. Front. Med., 9.","DOI":"10.3389\/fmed.2022.907992"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.ccm.2016.01.009","article-title":"Endothelial and Microcirculatory Function and Dysfunction in Sepsis","volume":"37","author":"Colbert","year":"2016","journal-title":"Clin. Chest Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1186\/s13054-018-2240-5","article-title":"Microcirculatory perfusion disturbances in septic shock: Results from the ProCESS trial","volume":"22","author":"Massey","year":"2018","journal-title":"Crit. Care"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e151","DOI":"10.5114\/amsad.2019.86754","article-title":"Impaired vascular reactivity in sepsis\u2014A systematic review with meta-analysis","volume":"4","author":"Kazune","year":"2019","journal-title":"Arch. Med. Sci. Atheroscler. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12959-019-0198-4","article-title":"Sepsis and septic shock: Endothelial molecular pathogenesis associated with vascular microthrombotic disease","volume":"17","author":"Chang","year":"2019","journal-title":"Thromb. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1186\/cc2353","article-title":"Bench-to-bedside review: Microvascular dysfunction in sepsis--hemodynamics, oxygen transport, and nitric oxide","volume":"7","author":"Bateman","year":"2003","journal-title":"Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Sturm, T., Leiblein, J., Clau\u00df, C., Erles, E., and Thiel, M. (2021). Bedside determination of microcirculatory oxygen delivery and uptake: A prospective observational clinical study for proof of principle. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-03922-4"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/s40560-025-00801-2","article-title":"Combination of Cv-aCO2\/Ca-vO2 and Pv-aCO2 as markers of resuscitation or microcirculation in patients with septic shock: A pilot study","volume":"13","author":"Cheng","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40560-024-00770-y","article-title":"Sepsis-induced cardiogenic shock: Controversies and evidence gaps in diagnosis and management","volume":"13","author":"Sato","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s00134-025-07782-8","article-title":"How we could use critical care echocardiography in the assessment of and management of cardiovascular phenotypes in septic shock: The good, the bad, and the ugly profiles","volume":"51","author":"Messina","year":"2025","journal-title":"Intensive Care Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Broman, L.M., Dubrovskaja, O., and Balik, M. (2023). Extracorporeal Membrane Oxygenation for Septic Shock in Adults and Children: A Narrative Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12206661"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1097\/ACO.0000000000001206","article-title":"Is venoarterial extracorporeal membrane oxygenation an option for managing septic shock","volume":"36","author":"Helwani","year":"2023","journal-title":"Curr. Opin. Anaesthesiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2478\/jccm-2024-0017","article-title":"Extracorporeal Membrane Oxygenation as Circulatory Support in Adult Patients with Septic Shock: A Systematic Review","volume":"10","author":"Khan","year":"2024","journal-title":"J. Crit. Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e12891","DOI":"10.1111\/micc.12891","article-title":"Microcirculatory Perfusion Disturbances During Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review","volume":"31","author":"Volleman","year":"2024","journal-title":"Microcirculation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"tkab017","DOI":"10.1093\/burnst\/tkab017","article-title":"Extracorporeal membrane oxygenation combined with continuous renal replacement therapy for the treatment of severe burns: Current status and challenges","volume":"9","author":"Song","year":"2021","journal-title":"Burn. Trauma"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S2213-2600(21)00451-3","article-title":"Extracorporeal haemoadsorption: Does the evidence support its routine use in critical care?","volume":"10","author":"Supady","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.athoracsur.2016.07.069","article-title":"The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Underwent Extracorporeal Membrane Oxygenation for Septic Shock","volume":"103","author":"Choi","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1016\/j.jtcvs.2016.08.038","article-title":"Predictors of survival in adults undergoing extracorporeal membrane oxygenation with severe infections","volume":"152","author":"Cheng","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1007\/s00431-018-3174-2","article-title":"Venoarterial extracorporeal membrane oxygenation support for neonatal and pediatric refractory septic shock: More than 15 years of learning","volume":"177","author":"Jordan","year":"2018","journal-title":"Eur. J. Pediatr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1016\/j.jtcvs.2018.03.123","article-title":"Extracorporeal life support for adults with refractory septic shock","volume":"156","author":"Ro","year":"2018","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e68","DOI":"10.1093\/ejcts\/ezu462","article-title":"Extracorporeal membrane oxygenation for refractory septic shock in adults","volume":"47","author":"Park","year":"2015","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"154258","DOI":"10.1016\/j.jcrc.2023.154258","article-title":"Refractory septic shock and alternative wordings: A systematic review of literature","volume":"75","author":"Antonucci","year":"2023","journal-title":"J. Crit. Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ijcard.2022.04.084","article-title":"Strategies to reduce limb ischemia in peripheral venoarterial extracorporeal membrane oxygenation: A systematic review and Meta-analysis","volume":"361","author":"Marbach","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s13054-019-2541-3","article-title":"Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: A narrative review of incidence, prevention, monitoring, and treatment","volume":"23","author":"Bonicolini","year":"2019","journal-title":"Crit. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1053\/j.jvca.2023.07.045","article-title":"Limb Ischemia in Femoral Venoarterial ECMO Patients: Cutting to the Chase?","volume":"37","author":"Ortoleva","year":"2023","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"39992","DOI":"10.31083\/RCM39992","article-title":"Harlequin Syndrome in Venoarterial ECMO and ECPELLA: When ECMO and Native or Impella Circulations Collide\u2014A Comprehensive Review","volume":"26","author":"Torre","year":"2025","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/ejcts\/ezaa397","article-title":"Right axillary artery cannulation for venoarterial extracorporeal membrane oxygenation: A retrospective single centre observational study","volume":"59","author":"Pisani","year":"2021","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Torre, D.E., and Pirri, C. (2025). Alternative Arterial Access in Veno-Arterial ECMO: The Role of the Axillary Artery. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155413"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.jtcvs.2019.10.078","article-title":"Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis","volume":"160","author":"Mariscalco","year":"2020","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s12055-020-00999-w","article-title":"Vascular access in ECMO","volume":"37","author":"Pooboni","year":"2021","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1111\/aor.14070","article-title":"Veno-arteriovenous extracorporeal membrane oxygenation-A single center experience","volume":"45","author":"Mihu","year":"2021","journal-title":"Artif. Organs."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1111\/aor.14610","article-title":"Utilization and outcomes of V-AV ECMO: A systematic review and meta-analysis","volume":"47","author":"Saxena","year":"2023","journal-title":"Artif. Organs."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/echo.15266","article-title":"Echocardiography for extracorporeal membrane oxygenation","volume":"39","author":"Hussey","year":"2022","journal-title":"Echocardiography"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"101965","DOI":"10.1016\/j.jacadv.2025.101965","article-title":"Optimal ECLS Support in Mixed Cardiogenic and Septic Shock: An ELSO Registry Analysis","volume":"4","author":"Labrada","year":"2025","journal-title":"JACC Adv."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.amjcard.2023.09.023","article-title":"Left Ventricular Unloading With Impella Versus IABP in Patients With VA-ECMO: A Systematic Review and Meta-Analysis","volume":"208","author":"Gandhi","year":"2023","journal-title":"Am. J. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Sandrio, S., Krebs, J., Leonardy, E., Thiel, M., and Schoettler, J.J. (2022). Vasoactive Inotropic Score as a Prognostic Factor during (Cardio-) Respiratory ECMO. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092390"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Mungan, \u0130., Kazanc\u0131, D., Bekta\u015f, \u015e., Ademoglu, D., and Turan, S. (2018). Does lactate clearance prognosticates outcomes in ECMO therapy: A retrospective observational study. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0618-1"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"ezae334","DOI":"10.1093\/ejcts\/ezae334","article-title":"Combining the vasoactive-inotropic score with lactate levels to predict mortality in post-cardiotomy patients supported with venoarterial extracorporeal membrane oxygenation","volume":"66","author":"Tian","year":"2024","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"150","DOI":"10.21037\/atm.2020.01.116","article-title":"Role of echocardiography in sepsis and septic shock","volume":"8","author":"Vallabhajosyula","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"P\u00e9rez, C., Diaz-Caicedo, D., Almanza Hern\u00e1ndez, D.F., Moreno-Araque, L., Yepes, A.F., and Carrizosa Gonzalez, J.A. (2024). Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. J. Clin. Med., 13.","DOI":"10.3390\/jcm13185344"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1186\/s13054-020-03345-z","article-title":"Right ventricular failure in septic shock: Characterization, incidence and impact on fluid responsiveness","volume":"24","author":"Prigent","year":"2020","journal-title":"Crit. Care"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11886-020-01277-2","article-title":"Sepsis-Induced Cardiomyopathy: A Comprehensive Review","volume":"22","author":"Sternberg","year":"2020","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_73","first-page":"313","article-title":"How to assess ventriculoarterial coupling in sepsis","volume":"26","author":"Pinsky","year":"2020","journal-title":"Curr. Opin. Crit. Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"795","DOI":"10.21037\/atm.2020.04.10","article-title":"Understanding ventriculo-arterial coupling","volume":"8","author":"Santos","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_75","first-page":"e1114","article-title":"Use of Speckle-Tracking Echocardiography in Septic Cardiomyopathy in Critically Ill Children: A Narrative Review","volume":"6","author":"Chan","year":"2024","journal-title":"Crit. Care Explor."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Yao, Y., Yang, Q., Zhong, M., He, H., and Song, J. (2025). Diagnostic and prognostic value of speckle tracking echocardiography for right ventricular dysfunction in sepsis: A retrospective observational study. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-05175-9"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s13054-017-1739-5","article-title":"Transpulmonary thermodilution: Advantages and limits","volume":"21","author":"Monnet","year":"2017","journal-title":"Crit. Care"},{"key":"ref_78","first-page":"214","article-title":"The role of pulse indicator continuous cardiac output (PiCCO) and critical care ultrasound in volume status assessment during fluid resuscitation for and prognosis of septic shock patients","volume":"39","author":"Luo","year":"2023","journal-title":"Pak. J. Med. Sci."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Persona, P., Valeri, I., Saraceni, E., De Cassai, A., Calabrese, F., and Navalesi, P. (2021). Cardiac Output Evaluation on Septic Shock Patients: Comparison between Calibrated and Uncalibrated Devices during Vasopressor Therapy. J. Clin. Med., 10.","DOI":"10.3390\/jcm10020213"},{"key":"ref_80","first-page":"345","article-title":"A possible role for the venous-to-arterial CO2 difference in cardiogenic shock: An exploratory study","volume":"35","author":"Andrea","year":"2023","journal-title":"Emergencias"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1186\/s13054-025-05513-5","article-title":"Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: Post-hoc analysis of the multicenter, randomized ECMO-CS trial","volume":"29","author":"Ostadal","year":"2025","journal-title":"Crit. Care"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1097\/CCM.0b013e31828a2370","article-title":"Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock","volume":"41","author":"Luyt","year":"2013","journal-title":"Crit. Care Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0140-6736(20)30733-9","article-title":"Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: A retrospective, multicentre, international cohort study","volume":"396","author":"Hajage","year":"2020","journal-title":"Lancet"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s40560-018-0352-2","article-title":"ECMO-treatment in patients with acute lung failure, cardiogenic, and septic shock: Mortality and ECMO-learning curve over a 6-year period","volume":"6","author":"Banjas","year":"2018","journal-title":"J. Intensive Care"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1097\/CCM.0000000000003819","article-title":"Extracorporeal Membrane Oxygenation for Septic Shock","volume":"47","author":"Falk","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/MAT.0000000000001933","article-title":"Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock","volume":"69","author":"Kim","year":"2023","journal-title":"ASAIO J."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.jtcvs.2012.08.022","article-title":"Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock","volume":"146","author":"Huang","year":"2013","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/0267659118766833","article-title":"Veno-arterio-venous ECMO for septic cardiomyopathy: A single-centre experience","volume":"33","author":"Vogel","year":"2018","journal-title":"Perfusion"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1186\/s13054-020-03418-z","article-title":"Role of extracorporeal membrane oxygenation in children with sepsis: A systematic review and meta-analysis","volume":"24","author":"Ramanathan","year":"2020","journal-title":"Crit. Care"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/PCC.0b013e3181e2a4a1","article-title":"Central extracorporeal membrane oxygenation for refractory pediatric septic shock","volume":"12","author":"MacLaren","year":"2011","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/01.PCC.0000282155.25974.8F","article-title":"Extracorporeal membrane oxygenation for refractory septic shock in children: One institution\u2019s experience","volume":"8","author":"Maclaren","year":"2007","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1542\/peds.93.5.726","article-title":"Extracorporeal membrane oxygenation for refractory septic shock in children","volume":"93","author":"Beca","year":"1994","journal-title":"Pediatrics"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0003-4975(96)01272-6","article-title":"Results of extracorporeal membrane oxygenation in children with sepsis. The Extracorporeal Life Support Organization","volume":"63","author":"Meyer","year":"1997","journal-title":"Ann. Thorac. Surg."},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Brown, T.N., and Brogan, T.V. (2023). Right ventricular dysfunction in patients with acute respiratory distress syndrome receiving venovenous extracorporeal membrane oxygenation. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1027300"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1186\/s13054-024-05101-z","article-title":"A narrative review on antimicrobial dosing in adult critically ill patients on extracorporeal membrane oxygenation","volume":"28","author":"Kim","year":"2024","journal-title":"Crit. Care"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.ijantimicag.2014.11.005","article-title":"\u03b2-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study","volume":"45","author":"Donadello","year":"2015","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"S629","DOI":"10.21037\/jtd.2017.09.154","article-title":"Optimising drug dosing in patients receiving extracorporeal membrane oxygenation","volume":"10","author":"Cheng","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Gomez, F., Veita, J., and Laudanski, K. (2022). Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides. Antibiotics, 11.","DOI":"10.3390\/antibiotics11030338"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3949\/ccjm.87a.18143","article-title":"Sepsis and septic shock: Guideline-based management","volume":"87","author":"Dugar","year":"2020","journal-title":"Cleve Clin. J. Med."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.cjtee.2020.09.006","article-title":"Successful cure of a patient with urosepsis using a combination of extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review","volume":"23","author":"Zhu","year":"2020","journal-title":"Chin. J. Traumatol."},{"key":"ref_101","first-page":"217","article-title":"Cytokine hemoadsorption with CytoSorb\u00ae in patients with sepsis: A systematic review and meta-analysis","volume":"35","year":"2023","journal-title":"Crit. Care Sci."},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Lother, A., Benk, C., Staudacher, D.L., Supady, A., Bode, C., Wengenmayer, T., and Duerschmied, D. (2019). Cytokine Adsorption in Critically Ill Patients Requiring ECMO Support. Front. Cardiovasc. Med., 6.","DOI":"10.3389\/fcvm.2019.00071"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Peitz, G.J., and Murry, D.J. (2023). The Influence of Extracorporeal Membrane Oxygenation on Antibiotic Pharmacokinetics. Antibiotics, 12.","DOI":"10.3390\/antibiotics12030500"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1097\/MAT.0000000000001230","article-title":"Thrombosis and Bleeding in Extracorporeal Membrane Oxygenation (ECMO) Without Anticoagulation: A Systematic Review","volume":"67","author":"Olson","year":"2021","journal-title":"ASAIO J."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"66","DOI":"10.21037\/acs.2018.12.09","article-title":"Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): Prevention and management of acute complications","volume":"8","author":"Koerner","year":"2019","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"104039","DOI":"10.1016\/j.iccn.2025.104039","article-title":"The effectiveness of NIRS technology to the early diagnosis of lower limb ischemia in patients on peripheral VA ECMO: A systematic review and meta-analysis","volume":"89","author":"Coelho","year":"2025","journal-title":"Intensive Crit. Care Nurs."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Krasivskyi, I., Gro\u00dfmann, C., Dechow, M., Djordjevic, I., Ivanov, B., Gerfer, S., Bennour, W., Kuhn, E., Sabashnikov, A., and Rahmanian, P.B. (2023). Acute Limb Ischaemia during ECMO Support: A 6-Year Experience. Life, 13.","DOI":"10.3390\/life13020485"},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Themas, K., Zisis, M., Kourek, C., Konstantinou, G., D\u2019Anna, L., Papanagiotou, P., Ntaios, G., Dimopoulos, S., and Korompoki, E. (2024). Acute Ischemic Stroke during Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review of the Literature. J. Clin. Med., 13.","DOI":"10.3390\/jcm13196014"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"e897","DOI":"10.1097\/CCM.0000000000004498","article-title":"Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry","volume":"48","author":"Cho","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Mornese Pinna, S., Sousa Casasnovas, I., Olmedo, M., Machado, M., Ju\u00e0rez Fern\u00e1ndez, M., Devesa-Cordero, C., Galar, A., Alvarez-Uria, A., Fern\u00e1ndez-Avil\u00e9s, F., and Garc\u00eda Carre\u00f1o, J. (2023). Nosocomial Infections in Adult Patients Supported by Extracorporeal Membrane Oxygenation in a Cardiac Intensive Care Unit. Microorganisms, 11.","DOI":"10.3390\/microorganisms11041079"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"e208081","DOI":"10.1212\/WNL.0000000000208081","article-title":"Long-Term Neuropsychiatric, Neurocognitive, and Functional Outcomes of Patients Receiving ECMO: A Systematic Review and Meta-Analysis","volume":"102","author":"Kalra","year":"2024","journal-title":"Neurology"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.jtcvs.2021.10.077","article-title":"Long-term survival and quality of life after extracorporeal membrane oxygenation","volume":"166","author":"Rossong","year":"2023","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"e959","DOI":"10.1097\/CCM.0000000000004488","article-title":"Cognitive, Psychiatric, and Quality of Life Outcomes in Adult Survivors of Extracorporeal Membrane Oxygenation Therapy: A Scoping Review of the Literature","volume":"48","author":"Khan","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_114","first-page":"e012476","article-title":"Long-Term Functional Outcomes in the First 12 Months After VA-ECMO in Adult Patients: A Prospective, Multicenter Study","volume":"18","author":"Higgins","year":"2025","journal-title":"Circ. Heart Fail."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/PCC.0000000000001612","article-title":"Neurologic Outcomes After Extracorporeal Membrane Oxygenation: A Systematic Review","volume":"19","author":"Boyle","year":"2018","journal-title":"Pediatr. Crit. Care Med."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1086\/JCE2022331013","article-title":"Ethics of Extracorporeal Membrane Oxygenation under Conventional and Crisis Standards of Care","volume":"33","author":"Piscitello","year":"2022","journal-title":"J. Clin. Ethics."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"E387","DOI":"10.1001\/amajethics.2019.387","article-title":"How Should ECMO Initiation and Withdrawal Decisions Be Shared?","volume":"21","author":"Jaramillo","year":"2019","journal-title":"AMA J. Ethics."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Clark, J.D., Baden, H.P., Berkman, E.R., Bourget, E., Brogan, T.V., Di Gennaro, J.L., Doorenbos, A.Z., McMullan, D.M., Roberts, J.S., and Turnbull, J.M. (2022). Ethical Considerations in Ever-Expanding Utilization of ECLS: A Research Agenda. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.896232"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jacc.2018.11.038","article-title":"Venoarterial ECMO for Adults: JACC Scientific Expert Panel","volume":"73","author":"Guglin","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Lautz, A.J., and Zingarelli, B. (2019). Age-Dependent Myocardial Dysfunction in Critically Ill Patients: Role of Mitochondrial Dysfunction. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20143523"},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1186\/s13054-021-03736-w","article-title":"Initial antimicrobial management of sepsis","volume":"25","author":"Niederman","year":"2021","journal-title":"Crit. Care"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Vincent, J.L. (2022). Current sepsis therapeutics. EbioMedicine, 86.","DOI":"10.1016\/j.ebiom.2022.104318"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"e70051","DOI":"10.1002\/jca.70051","article-title":"Developing a Protocol for Therapeutic Plasma Exchange in Tandem With Continuous Renal Replacement Therapy (CRRT) and ExtraCorporeal Membrane Oxygenation (ECMO) in Pediatric Patients","volume":"40","author":"Jacquot","year":"2025","journal-title":"J. Clin. Apher."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s41030-024-00265-z","article-title":"Short-Term Neurologic Complications in Patients Undergoing Extracorporeal Membrane Oxygenation Support: A Review on Pathophysiology, Incidence, Risk Factors, and Outcomes","volume":"10","author":"Pisano","year":"2024","journal-title":"Pulm. Ther."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1186\/s13054-024-05082-z","article-title":"Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines","volume":"28","author":"Cho","year":"2024","journal-title":"Crit. Care"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.chest.2024.07.173","article-title":"POINT: Is It Ethically Justifiable to Withdraw Extracorporeal Membrane Oxygenation Against the Wishes of a Patient With Decision-Making Capacity When Cure Is Not Possible? Yes","volume":"166","author":"Kon","year":"2024","journal-title":"Chest"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1016\/j.surg.2023.02.004","article-title":"A contemporary analysis of the volume-outcome relationship for extracorporeal membrane oxygenation in the United States","volume":"173","author":"Verma","year":"2023","journal-title":"Surgery"},{"key":"ref_128","first-page":"262","article-title":"Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months","volume":"26","author":"Ertugrul","year":"2024","journal-title":"Crit. Care Resusc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/7904\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T15:16:27Z","timestamp":1762528587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/22\/7904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":128,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14227904"],"URL":"https:\/\/doi.org\/10.3390\/jcm14227904","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]}}}