Pathophysiology of cardiac extracorporeal membrane oxygenation
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Published on: October 24, 2018
B P Fuhrman1, L J Hernan, A T Rotta
1State University of New York at Buffalo and Children's Hospital of Buffalo, 14222, USA.
Insights
In cardiogenic shock, treatments can increase cardiac workload. Extracorporeal membrane oxygenation (ECMO) aids circulation but may require left atrial decompression to prevent heart strain and pulmonary edema.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Cardiogenic shock treatments like inotropes and volume expansion increase cardiac workload.
- This increased cardiac work can lead to myocardial ischemia and cardiac arrest.
- Extracorporeal membrane oxygenation (ECMO) is a potential treatment for cardiogenic shock.
Purpose of the Study:
- To evaluate the role of ECMO in managing cardiogenic shock.
- To investigate the impact of ECMO on cardiac workload and myocardial perfusion.
- To determine the necessity of left atrial decompression in conjunction with ECMO.
Main Methods:
- Review of ECMO application in cardiogenic shock patients.
- Analysis of hemodynamic parameters during ECMO support.
- Assessment of factors influencing cardiac workload and left atrial pressure.
Main Results:
- ECMO supports systemic circulation and myocardial perfusion.
- Restoration of circulation via ECMO can increase afterload, potentially worsening cardiac function.
- Left atrial hypertension and pulmonary edema can occur despite ECMO, especially with shunts.
- Left atrial drainage or decompression may be crucial for reducing cardiac workload.
Conclusions:
- ECMO is a valuable tool for supporting circulation in cardiogenic shock.
- Reducing cardiac workload is critical, even with ECMO.
- Left atrial decompression is an important consideration in select ECMO patients to prevent complications.
Abstract:
The treatment of cardiogenic shock using inotropic agents and vascular volume expansion places an added burden on the heart. The resultant increase in cardiac work may cause myocardial ischemia and lead to cardiac arrest. Extracorporeal membrane oxygenation (ECMO) may be used to treat cardiogenic shock. It supports systemic circulation, assures diastolic perfusion of the myocardium, and reduces cardiac workload. The rise in blood pressure associated with restoring systemic circulation afterloads the heart and can cause left atrial hypertension and pulmonary edema. ECMO does not automatically reduce cardiac work, especially in the presence of residual shunts. Left atrial drainage or decompression may be essential in certain patients both to avert pulmonary edema and to reduce cardiac work.
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