The use of venoarterial-extracorporeal membrane oxygenation(VA-ECMO) was associated with lower in-hospital mortality in patients with cardiogenic shock. However, VA-ECMO has a deleterious effect for hemodynamics. It can increase left ventricular end-diastolic pressure(LVEDP), followed by left ventricular dilatation, abnormal opening of aortic valve and jeopardizes of myocardial recovery. Therefore, several methods have been used to reduce LVEDP. Among these, left atrial septostomy is effective, but less invasive than surgical left ventricular unloading. However, there is few data regarding this issue. Therefore, the investigators will evaluate the effect of routine, early left atrial septostomy in patients with VA-ECMO for the treatment of cardiogenic shock.
Inclusion Criteria:
1\) Age more than 18 years old 2) Cardiogenic shock\* 3) Successful VA-ECMO implantation
* The definition of cardiogenic shock All these criteria should be met
1. Systolic blood pressure \< 90 mmHg for 30 minutes, or needing inotrope or vasopressor to maintain systolic blood pressure \> or = 90 mmHg
2. Pulmonary congestion on chest X-ray or increased left ventricular filling pressure by cardiac catheterization
3. At least one criteria of organ dysfunction
\- mental obtundation, clammy skin, oliguria, renal dysfunction, increased level of blood lactate
Exclusion Criteria:
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1. VA-ECMO after open heart surgery
2. VA-ECMO for the treatment of non-cardiac shock
3. Severe bleeding\*
4. Terminal malignancy
5. Irreversible brain damage
6. Pregnancy or lactation
* The definition of severe bleeding Hemoglobin decrease after VA-ECMO or cannulation site bleeding is not a exclusion criteria
1. Hypovolemic shock due to definite bleeding cause
2. Identifiable bleeding causes: gastrointestinal bleeding, hemothorax, traumatic bleeding, central nervous system hemorrhage, pulmonary hemorrhage