Critical Care Medicine
Dr. Nancy Reid
Venoarterial ECMO is a widely used treatment modality for patients with cardiogenic shock and left ventricular failure. Utilization of VA-ECMO in patients with left ventricular failure can result in increased left ventricular afterload and thus left ventricular distention.1 In patients with cardiac failure the heart is not pumping normally and thus is not able to eject blood from the left ventricle. In this situation, the left ventricle can become distended without a “vent” which decompresses it before it becomes overdistended.2 There are several options for left ventricular venting, including direct cannulation of the left atrium or left ventricle via surgical thoracotomy, transseptal atriotomy performed via catheter in the catheterization lab, percutaneous placement of Intra-Aortic Balloon Pump (IABP) for reduction of left ventricular afterload, and percutaneous placement of Impella. Of the above options for left ventricular venting, the IABP and the Impella are the least invasive, with placement accomplished percutaneously.2,3 Impella is the most versatile and provides the most support to the left ventricle. Because the need for ventricular decompression is present in patients with cardiac failure, among the least invasive treatment options for left ventricular distention, is placement of percutaneous Impella for venting the left ventricle and reducing left ventricular afterload. Outcomes related to this use of Impella for left ventricular venting in VA-ECMO are in question.4
Cockram B. Is there survival benefit in utilization of Impella for left ventricular venting in VA-ECMO?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(1).
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