Cardiovascular Critical Care
Dr. Nancy Reid, MHA, DHSc, PA-C
Purpose: This analysis summarizes available literature surrounding the concept of pathologic LV distention and the associated sequelae, in patients on peripheral VA ECMO. Simultaneously, it seeks to determine whether an LV venting strategy can be used to successfully treat or prevent these complications.
Method: A PubMed literature search was conducted with search terms VA ECMO, peripheral, acute lung injury ALI), pulmonary edema, left ventricle (LV) vent, and LV distention. Twenty-one articles were available for review and are the basis for this analysis.
Results: A poorly contractile LV may not allow for aortic valve opening against the increased afterload caused by the retrograde blood flow in peripherally inserted VA ECMO. Consequently, LV distention and resultant pressure/volume overload will result. This causes pulmonary edema, increased LV wall strain, increased myocardial oxygen consumption, and increased risk of LV thrombus formation as complications of peripheral VA ECMO under these conditions. Decompressing the LV by means of a percutaneous or surgical vent, can potentially prevent these complications by decreasing the left ventricle end diastolic pressure and subsequent reflected fluid/pressure into the lungs. Observational studies have shown that patients who do not suffer acute lung injury (ALI) from pulmonary edema have improved survival compared to subjects who suffer from pulmonary edema and ALI.
Conclusion: Complications of peripheral VA ECMO can limit survival. Pulmonary edema, LV thrombus formation and increased myocardial oxygen consumption may result in higher morbidity and mortality. A randomized trial of LV vents in patients requiring VA ECMO, may elucidate if LV venting would decrease these complications and increase survival to discharge.
Keywords: Peripheral VA ECMO, Pulmonary Edema, LV Distention, LV vent, ALI
Raval P. To Vent, or Not to Vent? Left Ventricle Decompression in Peripheral VA ECMO. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2019; 1(4).
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