ECMO and Critical Care
Dr. Nancy Reid, MHA, DHSc, PA-C, DFAAPA
Purpose: The purpose of this review is to examine the role of left ventricular (LV) decompression during venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of severe cardiogenic shock.
Methods: A Medline search using the terms venoarterial extracorporeal membrane oxygenation or VA-ECMO and cardiogenic shock and left ventricular unloading resulted in a total of 18 articles. Seven articles were rejected for being older than five years or irrelevant. A second Ovid search using the terms left ventricular distention (LVD) and VA-ECMO and unloading the LV resulted in 27 articles. The case reports, duplicate articles, and those more than five years old were excluded. Eleven articles from the initial search, 17 articles from the subsequent search, and eight articles retrieved from reference lists are the basis of this review.
Results: There is a dearth of research describing the early diagnosis and a standardized approach to mitigate LVD resulting from VA-ECMO.
Conclusion: VA-ECMO is utilized in the resuscitation of patients suffering from severe CS and can stabilize the hemodynamic status, reduce myocardial oxygen demand, and support peripheral perfusion. The inherent inability to unload the failing LV remains the Achille’s heel of this therapy and it drives the need for continuous monitoring and early detection of LVD. There is an evolving experience in the care of severe CS patients supported with trans aortic VADs without implantation of ECMO indicating improved outcomes when the LV is unloaded.36 Moreover, observational studies listed herein suggest survival benefits when LVD is avoided.18 Moving forward, randomized prospective studies will help to discern superiority between the various LV decompressive techniques and the timing of their implementation in the effort to mitigate this troubling side effect of VA-ECMO.
Brookshire, Robert S.
"VenoArterial ECMO: To Vent or Not to Vent,"
Lynchburg Journal of Medical Science: Vol. 2
, Article 10.
Available at: https://digitalshowcase.lynchburg.edu/dmscjournal/vol2/iss3/10
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