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. 2019 Mar;11(3):865-872.
doi: 10.21037/jtd.2019.01.110.

Efficacy of left heart decompression during extracorporeal membrane oxygenation: a case-control study

You Jung Ok  1 , Sung-Ho Jung  1 , Seung-Whan Lee  2 , Jung-Min Ahn  2 , Ju Yong Lim  3
Affiliations

Efficacy of left heart decompression during extracorporeal membrane oxygenation: a case-control study

You Jung Ok et al. J Thorac Dis. 2019 Mar.

Abstract

Background: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is used in various cardiogenic shocks. In severe myocardial dysfunction, left heart (LH) distension may occur and aggravate pulmonary edema. Despite the recent case reports on various venting catheter insertion methods for LH decompression, the necessity and efficacy of LH venting procedure are still controversial. Therefore, we focused on evaluating efficacy of LH venting catheter insertion for LH decompression.

Methods: In total, 373 patients received VA ECMO at our institution from May 2012 to January 2016. Of these, 25 patients underwent LH venting catheter insertion. Indication for the procedure included pulmonary congestion observed on chest radiogram, with arterial pulse pressure ≤10 mmHg. The control group comprised of 45 patients with peripheral VA ECMO having arterial pulse pressure ≤ for ≥24 hours during the same study period who did not undergo LH venting procedure. Finally, 70 patients were compared and analyzed.

Results: Mean age of the patients was 52.6±17.1 years. The ECMO running time in each group was 7.2±7.1 days in the vent (-) group and 9.2±8.5 days in the vent (+) group. Successful weaning rate was higher in the LH vent (+) group (P=0.08). Moreover, LH venting catheter insertion was identified as a predictor of weaning success with marginal significance (OR =2.47; 95% CI: 0.90-6.72; P=0.07).

Conclusions: LH decompression by venting catheter insertion in patients on VA ECMO may be more effective and helpful for successful ECMO weaning than conventional medical management without survival benefit.

Keywords: Veno-arterial extracorporeal membrane oxygenation (VA ECMO); left heart decompression (LH decompression); trans-septal venting catheter insertion.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart of 70 patients on VA ECMO. VA, veno-arterial; ECMO, extracorporeal membrane oxygenation; HT, heart transplantation; LH, left heart.
Figure 2
Figure 2
Venting catheter insertion procedure. (A) The trans-septal puncture was performed with a trans-septal needle; (B) a guidewire was positioned in the LA through septal puncture; (C) the punctured interatrial septum was dilated with a dilator; (D) a venous cannula was used and introduced into the left atrium by a guidewire. LA, left atrium.
Figure 3
Figure 3
Drainage cannulae configuration after LH venting on chest X-ray. (A) Chest X-ray before LH venting cannula insertion. Venous drainage cannula was placed in RA (see black arrow); (B) chest X-ray after LH venting cannula insertion. Another venous drainage cannula was placed in LA (see white arrow). LH, left heart; RA, right atrium; LA, left atrium.
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