Extracorporeal Membranous Oxygenation and Left Atrial Decompression: A Fast and Minimally Invasive Approach

Fouilloux, Virginie; Lebrun, Lionel; Macé, Loı̈c; Kreitmann, Bernard

doi:10.1016/j.athoracsur.2011.01.005

Cited by 31 publications

(28 citation statements)

References 7 publications

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“…Prior studies have not investigated the impact of percutaneous LA decompression on outcomes in ECMO patients www.pccmjournal.org January 2015 • Volume 16 • Number 1 (6)(7)(8)(12)(13)(14)(15). Based on current literature, it is unknown whether any particular transcatheter techniques of left heart decompression are superior or whether the timing of intervention has an impact on patient survival.…”

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confidence: 99%

Percutaneous Left Atrial Decompression in Patients Supported With Extracorporeal Membrane Oxygenation for Cardiac Disease*

Eastaugh

Thiagarajan

Darst

et al. 2015

Pediatric Critical Care Medicine

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Left atrial decompression can be performed effectively in children on extracorporeal membrane oxygenation using various percutaneous techniques. Reduction in pulmonary venous congestion is usually evident by chest radiography within 48 hours of intervention. Persistent atrial septal defect may require closure at the time of extracorporeal membrane oxygenation decannulation or during long-term follow-up.

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confidence: 99%

Percutaneous Left Atrial Decompression in Patients Supported With Extracorporeal Membrane Oxygenation for Cardiac Disease*

Eastaugh

Thiagarajan

Darst

et al. 2015

Pediatric Critical Care Medicine

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“…A number of studies have demonstrated that adequate LV decompression can prevent these complications (11)(12)(13). In pediatric patients on ECMO, decompression of the left heart has been attempted through blade atrial septostomy (14), balloon atrial septostomy (14)(15)(16)(17)(18), blade-and-balloon atrial septostomy (17,19,20), left atrial stents/sheaths (4,15,(21)(22)(23)(24), and LV stents/sheaths (21,25,26). The complications reported from left heart decompression include bleeding (either surgical or from the cannulation site), hemolysis, right atrial perforation, air in the circuit, and central nervous system bleeding (15).…”

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confidence: 99%

Elective Decompression of the Left Ventricle in Pediatric Patients May Reduce the Duration of Venoarterial Extracorporeal Membrane Oxygenation

et al. 2014

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We aimed to determine the effect of elective left heart decompression at the time of initiation of central venoarterial extracorporeal membrane oxygenation (VA ECMO) on VA ECMO duration and clinical outcomes in children in a single tertiary ECMO referral center with a large pediatric population from a national referral center for pediatric cardiac surgery. We studied 51 episodes of VA ECMO in a historical cohort of 49 pediatric patients treated between the years 1990 and 2013 in the Paediatric Intensive Care Unit (PICU) of the Royal Children's Hospital, Melbourne. The cases had a variety of diagnoses including congenital cardiac abnormalities, sepsis, myocarditis, and cardiomyopathy. Left heart decompression as an elective treatment or an emergency intervention for left heart distension was effectively achieved by a number of methods, including left atrial venting, blade atrial septostomy, and left ventricular cannulation. Elective left heart decompression was associated with a reduction in time on ECMO (128 h) when compared with emergency decompression (236 h) (P = 0.013). Subgroup analysis showed that ECMO duration was greatest in noncardiac patients (elective 138 h, emergency 295 h; P = 0.02) and in patients who died despite both emergency decompression and ECMO (elective 133 h, emergency 354 h; P = 0.002). As the emergency cases had a lower pH, a higher PaCO2 , and a lower oxygenation index and were treated with a higher mean airway pressure, positive end-expiratory pressure, and respiratory rate prior to receiving VA ECMO, we undertook multivariate linear regression modeling to show that only PaCO2 and the timing of left heart decompression were associated with ECMO duration. However, elective left heart decompression was not associated with a reduction in length of PICU stay, duration of mechanical ventilation, or duration of oxygen therapy. Elective left heart decompression was not associated with improved ECMO survival or survival to PICU discharge. Elective left heart decompression may reduce ECMO duration and has therefore the potential to reduce ECMO-related complications. A prospective, randomized controlled trial is indicated to study this intervention further.

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“…Venovenous ECMO is our standard approach for severe ARDS, and venoarterial ECMO is typically used for cardiac failure, both of which were present in this patient. [6][7][8] These approaches would have required more time and precluded expedient transfer. 6,7 Given the risk of exacerbating his aortic insufficiency, we decided to support his oxygenation with venovenous ECMO for transport with plans for emergent AVR at our facility after a confirmatory TEE.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Transport after Traumatic Aortic Valve Injury

et al. 2014

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Traumatic injury to the aortic valve is an uncommon clinical entity. Rarer still is the transport of such a patient using extracorporeal membrane oxygenation (ECMO) to a specialized ECMO center for definitive repair. We present a case of traumatic rupture of the aortic valve complicated by severe acute respiratory distress syndrome with interhospital transport using ECMO and subsequent aortic valve replacement.

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Extracorporeal Membranous Oxygenation and Left Atrial Decompression: A Fast and Minimally Invasive Approach

Cited by 31 publications

References 7 publications

Percutaneous Left Atrial Decompression in Patients Supported With Extracorporeal Membrane Oxygenation for Cardiac Disease*

Percutaneous Left Atrial Decompression in Patients Supported With Extracorporeal Membrane Oxygenation for Cardiac Disease*

Elective Decompression of the Left Ventricle in Pediatric Patients May Reduce the Duration of Venoarterial Extracorporeal Membrane Oxygenation

Extracorporeal Membrane Oxygenation Transport after Traumatic Aortic Valve Injury

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