Venoarterial extracorporeal membrane oxygenation (VA-ECMO) usually provides hemodynamic support for patients with cardiogenic shock (CS) and cardiac arrest, ensuring organ perfusion and leaving time for revascularization and reperfusion. Although ECMO technology is developing rapidly, it still faces many challenges in clinical practice. Through the analysis of key studies on VA-ECMO at home and abroad in recent years, this article summarizes the progress of VA-ECMO and its combination strategy, the key points of prevention and management of major complications, the standardized withdrawal process and prognosis evaluation, and explore the value of clinical application and development trend in future, aim to provide reference for optimizing individualized treatment decisions. In the future, we can focus on three major directions: etiological stratification research, complication technology research, and AI-driven individual decision-making. As a result, it will realize the shift from "generalized support" to "precise intervention", maximize the balance of risks and benefits and establish a more accurate ECMO management system.