Left Ventricular Unloading During Extracorporeal Life Support: Current Practice.

Aniket S Rali, Eric J Hall, Raymond Dieter, Sagar Ranka, Andrew Civitello, Matthew D Bacchetta, Ashish S Shah, Kelly Schlendorf, Joann Lindenfeld, Subhasis Chatterjee

Journal: Journal of cardiac failure 2022;28(8):1326-1336

PMID: 34936896

Full Text on Elsevier Science View on PubMed

Abstract

Venoarterial extracorporeal life support (VA-ECLS) is a powerful tool that can provide complete cardiopulmonary support for patients with refractory cardiogenic shock. However, VA-ECLS increases left ventricular (LV) afterload, resulting in greater myocardial oxygen demand, which can impair myocardial recovery and worsen pulmonary edema. These complications can be ameliorated by various LV venting strategies to unload the LV. Evidence suggests that LV venting improves outcomes in VA-ECLS, but there is a paucity of randomized trials to help guide optimal strategy and the timing of venting. In this review, we discuss the available evidence regarding LV venting in VA-ECLS, explain important hemodynamic principles involved, and propose a practical approach to LV venting in VA-ECLS.

Address: Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: [email protected].; Division of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, Kansas.; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas; Department of Cardiology, Texas Heart Institute, Houston, Texas.; Division of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.; Divisions of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.

DOI: 10.1016/j.cardfail.2021.12.002

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MeSH Terms: Extracorporeal Membrane Oxygenation, Heart Failure, Heart Ventricles, Hemodynamics, Humans, Shock, Cardiogenic