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Review
. 2018 Mar;10(Suppl 5):S674-S682.
doi: 10.21037/jtd.2017.10.75.

Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation

Jeroen J H Bunge  1 , Kadir Caliskan  2 , Diederik Gommers  1 , Dinis Reis Miranda  1
Affiliations
Review

Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation

Jeroen J H Bunge et al. J Thorac Dis. 2018 Mar.

Abstract

Severe ARDS can be complicated by right ventricular (RV) failure. The etiology of RV failure in ARDS is multifactorial. Vascular alterations, hypoxia, hypercapnia and effects of mechanical ventilation may play a role. Echocardiography has an important role in diagnosing RV failure in ARDS patients. Once extracorporeal membrane oxygenation (ECMO) is indicated in these patients, the right ECMO modus needs to be chosen. In this review, the etiology, diagnosis and management of RV failure in ARDS will be briefly outlined. The beneficial effect of veno-venous (VV) ECMO on RV function in these patients will be illustrated. Based on this, we will give recommendations regarding choice of ECMO modus and provide an algorithm for management of RV failure in VV ECMO supported patients.

Keywords: Acute respiratory distress syndrome (ARDS); cor pulmonale; extracorporeal membrane oxygenation (ECMO); heart failure; human; right sided; veno-venous extracorporeal membrane oxygenation (VV ECMO).

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Conflict of interest statement

Conflicts of Interest: D Gommers is a member of the medical advisory board of Novalung and received travel expenses and fees for giving oral presentations from Novalung and Maquet; D Reis Miranda received speaking fees for oral presentation from Novalung and Hillrom. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Algorithm for choice of ECMO modus. ARDS, adult respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; VV, veno-venous; VA, veno-arterial; RV, right ventricular; LV, left ventricular; PA, pulmonary artery.
Figure 2
Figure 2
Management of circulatory failure after starting VV ECMO. VV ECMO, veno-venous extracorporeal membrane oxygenation; Vt, tidal volume; RV, right ventricular; VAV, veno-arterial and venous.
See this image and copyright information in PMC

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