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Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in
Yu-Tsung Shih1,2,3,4, Hung-Chang Jong1,2,3, Chia-Cheng Lin1,3
1Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Background:
Left ventricular/left ventricle (LV) overload remains a major limitation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock. Left atrial veno-arterial extracorporeal membrane oxygenation (LAVA-ECMO) has been proposed to facilitate LV unloading; however, data regarding its optimal timing and clinical role remain limited.
Methods:
This single-center retrospective cohort study evaluated the efficacy and safety of a preventive single-inflow cannula LAVA-ECMO strategy, defined as an a priori LV unloading approach implemented at extracorporeal membrane oxygenation (ECMO) initiation, either through primary LAVA-ECMO implantation or planned early conversion from VA-ECMO within 60 minutes. Between January 2020 and July 2025, eligible patients supported with VA-ECMO or LAVA-ECMO were screened. After predefined exclusions, 42 patients managed with preventive LAVA-ECMO were compared with 64 contemporaneous patients receiving conventional VA-ECMO.
Results:
Thirty-day all-cause mortality was lower in the LAVA-ECMO group than in the VA-ECMO group (47.6% vs 76.6%; adjusted hazard ratio, 0.54; 95% CI, 0.31-0.95). Failure to wean from ECMO tended to occur less frequently with LAVA-ECMO (31.0% vs 56.3%; adjusted odds ratio, 0.43; 95% CI, 0.18-1.01). Signs of LV overload during ECMO support were significantly reduced in the LAVA-ECMO group (47.6% vs 82.8%; adjusted odds ratio, 0.19, 95% CI, 0.08-0.49). Overall complication rates were comparable between groups.
Conclusions:
In this retrospective cohort, preventive LAVA-ECMO was associated with lower short-term mortality and a reduced incidence of LV overload without an apparent increase in complications. Preventive LAVA-ECMO may represent a feasible mechanical circulatory support strategy in carefully selected patients with cardiogenic shock.
