In which clinical scenarios is VA ECMO typically indicated?

VA (Venoarterial) ECMO is primarily utilized in scenarios involving cardiac failure or cardiogenic shock. This is because VA ECMO provides both cardiac and respiratory support by draining deoxygenated blood from the vena cava and returning oxygenated blood to the aorta. In cases of severe cardiac failure, where the heart is unable to effectively pump blood to meet the body's needs, VA ECMO takes over the role of the heart, ensuring adequate perfusion and oxygen delivery to vital organs.

In contrast, while severe respiratory failure may warrant ECMO support, it typically aligns more with VV (Venovenous) ECMO, which specifically addresses lung function without directly supporting cardiac output. Conditions such as chronic obstructive pulmonary disease (COPD) or asthma exacerbations primarily affect the respiratory system and do not involve the heart's pumping action, making VA ECMO less appropriate for those situations. Therefore, the indication of VA ECMO is firmly anchored in its ability to support patients experiencing cardiac failure or cardiogenic shock, making it the correct choice in this context.