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Review
. 2019 Apr;11(4):1676-1683.
doi: 10.21037/jtd.2019.03.29.

Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation

Marisa Cevasco  1 , Hiroo Takayama  1 , Masahiko Ando  1 , Arthur R Garan  2 , Yoshifumi Naka  1 , Koji Takeda  1
Affiliations
Review

Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation

Marisa Cevasco et al. J Thorac Dis. 2019 Apr.

Abstract

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is an established method of short-term mechanical support for patients in cardiogenic shock, but can create left ventricular (LV) distension. This paper analyzes the physiologic basis of this phenomenon and treatment methods. This is a retrospective review of the existing literature on VA ECMO and LV distension. We undertook a PubMed review of all peer-reviewed papers focusing on VA ECMO, LV distension, and LV venting. We reviewed these papers and synthesized our findings. We also will discuss the various methods of LV venting and venting strategies we use at Columbia. LV distension is becoming an increasingly appreciated aspect of caring for patients on VA ECMO support. The literature demonstrates that the consequences of failing to anticipate, recognize, and treat LV distension are grave, and will worsen an already distended and hypocontractile LV. Myocardial recovery will be hindered, and LV thrombus formation more likely. Early recognition and aggressive management of LV distension is paramount in helping care for this critically ill patient population.

Keywords: LV venting; Venoarterial extracorporeal membrane oxygenation (VA ECMO); high afterload; left ventricular distension (LV distension).

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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
LV distension as seen on transesophageal echocardiogram. LV, left ventricular.
Figure 2
Figure 2
Aortic root thrombus as seen on transesophageal echocardiogram.
Figure 3
Figure 3
Chest X-ray showing ECpella, with Impella device in the LV and ECMO venous cannula extending from the inferior vena cava into the right atrium. LV, left ventricular; ECMO, extracorporeal membrane oxygenation.
Figure 4
Figure 4
Minimally invasive LV venting through the use of a CentriMag ventricular assist device (VAD) integrated with ECMO (A) and then after conversion to CentriMag VAD (B). LV, left ventricular; ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

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