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Updated: Sep 24, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Left Atrial Decompression in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation for Failure to
Francesca Sperotto1,2, Angelo Polito3, Angela Amigoni2
1Department of Cardiology Boston Children's HospitalHarvard Medical School Boston MA.
Insights
Left atrial decompression during extracorporeal membrane oxygenation (ECMO) may improve outcomes for children needing mechanical support after heart surgery. This intervention appears to reduce the risk of adverse events in pediatric patients who cannot be weaned from bypass.
Area of Science:
- Pediatric Cardiac Surgery
- Extracorporeal Life Support
- Cardiovascular Physiology
Background:
- Left atrial (LA) decompression during extracorporeal membrane oxygenation (ECMO) can aid myocardial rest and recovery.
- Potential benefits include protection from lung injury secondary to cardiogenic pulmonary edema.
- Clinical benefits of LA decompression in this context remain largely unknown.
Purpose of the Study:
- To evaluate the association between LA decompression and in-hospital adverse outcomes.
- Focus on pediatric patients (<18 years) failing to wean from cardiopulmonary bypass (CPB) requiring venoarterial ECMO.
- Utilize propensity score analysis to adjust for baseline differences between groups.
Main Methods:
- Retrospective analysis of pediatric patients with biventricular physiology from the ELSO Registry (2000-2016).
- Inclusion criteria: failure to wean from CPB requiring venoarterial ECMO.
- Inverse probability of treatment weighted logistic regression applied to assess LA decompression's impact.
Main Results:
- 279 of 1508 eligible patients (18%) underwent LA decompression (LA+).
- LA+ patients had different baseline characteristics but were well-balanced after propensity weighting.
- In-hospital adverse outcomes occurred in 47% of LA+ patients versus 51% of others; LA decompression was protective (aOR 0.775).
Conclusions:
- LA decompression was independently associated with a decreased risk of in-hospital adverse outcomes.
- Suggests potential benefit of LA decompression in pediatric venoarterial ECMO patients failing CPB weaning.
- Further investigation into LA decompression strategies in this critical patient population is warranted.
Abstract:
Background Left atrial (LA) decompression on extracorporeal membrane oxygenation (ECMO) can reduce left ventricular distension, allowing myocardial rest and recovery, and protect from lung injury secondary to cardiogenic pulmonary edema. However, clinical benefits remain unknown. We sought to evaluate the association between LA decompression and in-hospital adverse outcome (mortality, transplant on ECMO, or conversion to ventricular assist device) in patients who failed to wean from cardiopulmonary bypass using a propensity score to adjust for baseline differences. Methods and Results Children (aged <18 years) with biventricular physiology supported with ECMO for failure to wean from cardiopulmonary bypass after cardiac surgery from 2000 through 2016, reported to the ELSO (Extracorporeal Life Support Organization) Registry, were included. Inverse probability of treatment weighted logistic regression was used to test the association between LA decompression and in-hospital adverse outcomes. Of the 2915 patients supported with venoarterial ECMO for failure to wean from cardiopulmonary bypass, 1508 had biventricular physiology and 279 (18%) underwent LA decompression (LA+). Genetic and congenital abnormalities (P=0.001) and pulmonary hypertension (P=0.010) were less frequent and baseline arrhythmias (P=0.022) were more frequent in LA+ patients. LA+ patients had longer pre-ECMO mechanical ventilation and CBP time (P<0.001), and used aortic cross-clamp (P=0.001) more frequently. Covariates were well balanced between the propensity-weighted cohorts. In-hospital adverse outcomes occurred in 47% of LA+ patients and 51% of the others. Weighted multivariate logistic regression showed LA decompression to be protective for in-hospital adverse outcomes (adjusted odds ratio, 0.775 [95% CI, 0.644-0.932]). Conclusions LA decompression independently decreased the risk of in-hospital adverse outcome in pediatric venoarterial ECMO patients who failed to wean from cardiopulmonary bypass, suggesting that these patients may benefit from LA decompression.
