Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) supports patients with refractory cardiogenic shock.
• However, VA-ECMO can cause left ventricular (LV) overload and pulmonary edema.
• This review examines LV overload in adult and pediatric VA-ECMO patients.

Purpose of the Study:

• To investigate the incidence, diagnosis, risk factors, prevention, and interventions for LV overload in VA-ECMO patients.
• To synthesize current evidence on managing LV overload in this population.

Main Methods:

• Searched five electronic databases (MEDLINE, EMBASE, PubMed, CENTRAL, Cochrane) up to January 2018.
• Included all original published studies on adult and pediatric VA-ECMO with LV overload.
• Excluded abstracts and conference presentations.

Main Results:

• Incidence and sequelae of LV overload are highly variable.
• Presentations include pulmonary hypertension, LV distention, pulmonary edema, LV thrombosis, and arrhythmias.
• No standardized diagnostic criteria or intervention guidelines exist.
• LV decompression techniques vary, including surgical venting, percutaneous catheterization, VADs, and IABP.

Conclusions:

• Left ventricular distention is a significant VA-ECMO complication.
• Sequelae include myocardial ischemia, pulmonary edema, and thrombosis.
• Further research is needed on incidence, diagnostics, risk factors, and optimal LV decompression strategies.