Pharmacology of vasopressors and inotropes during extracorporeal membrane oxygenation

This review aims to provide a concise summary of hemodynamic considerations and the pharmacology and current evidence of vasoactive support, including inotropes and vasopressors, during extracorporeal membrane oxygenation (ECMO) support. Patients requiring ECMO for cardiogenic shock or cardiac arrest have a high mortality rate. Despite advancements in medical and mechanical therapies, optimal use of vasoactive in patients receiving venoarterial ECMO is not well defined. Venoarterial ECMO introduces unique hemodynamic disturbances and considerations for the provision of vasoactive medications. Many different pharmacotherapies with varying inotropic, vasoconstrictive, and vasodilating effects are available and include catecholamine and non-catecholamine agents. Mechanisms and level of evidence vary based on agent, yet distinct characteristics may make certain agents more attractive than others depending on the clinical situation faced during ECMO. A nuanced understanding of receptor pharmacology and ECMO specific considerations is essential to tailor the vasoactive strategy in this unique population.