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Review
. 2021 Mar 16;11(3):209.
doi: 10.3390/membranes11030209.

Modalities of Left Ventricle Decompression during VA-ECMO Therapy

Juan Pablo Ricarte Bratti  1 , Yiorgos Alexandros Cavayas  1   2 , Pierre Emmanuel Noly  1 , Karim Serri  1   2 , Yoan Lamarche  1   2
Affiliations
Review

Modalities of Left Ventricle Decompression during VA-ECMO Therapy

Juan Pablo Ricarte Bratti et al. Membranes (Basel). .

Abstract

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to sustain circulatory and respiratory support in patients with severe cardiogenic shock or refractory cardiac arrest. Although VA-ECMO allows adequate perfusion of end-organs, it may have detrimental effects on myocardial recovery. Hemodynamic consequences on the left ventricle, such as the increase of afterload, end-diastolic pressure and volume, can lead to left ventricular (LV) distention, increase of myocardial oxygen consumption and delayed LV function recovery. LV distention occurs in almost 50% of patients supported with VA-ECMO and is associated with an increase in morbidity and mortality. Thus, recognizing, preventing and treating LV distention is key in the management of these patients. In this review, we aim to discuss the pathophysiology of LV distention and to describe the strategies to unload the LV in patients supported with VA-ECMO.

Keywords: VA-ECMO; left ventricular assist device; left ventricular distention; left ventricular venting.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Algorithm proposed for left ventricular venting in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Abbreviations: LV, left ventricular; LVEDP, left ventricular end-diastolic pressure; MAP, mean arterial pressure; IABP, intra-aortic balloon pump; LA, left atrial.
See this image and copyright information in PMC

References

    1. Wayangankar S.A., Bangalore S., McCoy L.A., Jneid H., Latif F., Karrowni W., Charitakis K., Feldman D.N., Dakik H.A., Mauri L., et al. Temporal Trends and Outcomes of Patients Undergoing Percutaneous Coronary Interventions for Cardiogenic Shock in the Setting of Acute Myocardial Infarction: A Report from the CathPCI Registry. JACC Cardiovasc. Interv. 2016;9:341–351. doi: 10.1016/j.jcin.2015.10.039. - DOI - PubMed
    1. Bartlett R.H., Gazzaniga A.B., Fong S.W., Jefferies M.R., Roohk H.V., Haidu N. Extracorporeal membrane oxygenator support for cardiopulmonary failure. Experience in 28 cases. J. Thorac. Cardiovasc. Surg. 1977;73:375–386. doi: 10.1016/S0022-5223(19)39916-7. - DOI - PubMed
    1. Martin G.B., Rivers E.P., Paradis N.A., Goetting M.G., Morris D.C., Nowak R.M. Emergency department cardiopulmonary bypass in the treatment of human cardiac arrest. Chest. 1998;113:743–751. doi: 10.1378/chest.113.3.743. - DOI - PubMed
    1. Martin G.R., Short B.L. Doppler echocardiographic evaluation of cardiac performance in infants on prolonged extracorporeal membrane oxygenation. Am. J. Cardiol. 1988;62:929–934. doi: 10.1016/0002-9149(88)90895-8. - DOI - PubMed
    1. Bavaria J.E., Ratcliffe M.B., Gupta K.B., Wenger R.K., Bogen D.K., Edmunds L.H., Jr. Changes in left ventricular systolic wall stress during biventricular circulatory assistance. Ann. Thorac. Surg. 1988;45:526–532. doi: 10.1016/S0003-4975(10)64525-0. - DOI - PubMed

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