Left heart decompression in patients supported with extracorporeal membrane oxygenation for cardiac disease

Ong, Chin Siang; Hibino, Narutoshi

doi:10.5114/aic.2017.66179

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…Identifying LV dilatation and pulmonary edema during V-A ECMO support is very important for patient management. There are several clinical indicators that can be used to monitor and identify patients at risk [58]. In the simplest terms, the presence and extent of aortic valve opening can be detected in arterial pulse pressure tracings.…”

Section: Identify Patients At Risk Of Developing LV Distention and Pu...mentioning

confidence: 99%

Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review

Yin

2023

Intensive Care Res

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Background The use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiorespiratory support is increasing. However, few criteria for hemodynamic management have been described yet in V-A ECMO patients. Method We performed a review of hemodynamic management during V-A ECMO in CS patient based the literature published. We discuss how to optimize hemodynamic management. Results Patients on V-A ECMO require special hemodynamic management. It is crucial to maintain an adequate tissue oxygen supply and demand balance. Hemodynamic optimization is essential to support LV decompression and improve end-organ function and should be initiated immediately after initiating V-A ECMO support, during which more positive fluid balance is associated with worse outcomes. Conclusion The hemodynamic management of CS patients with V-A ECMO are complex and involves various aspect. Clinicians who care for patients on VA ECMO should combined use many availability indicators to guide hemodynamic management.

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Section: Identify Patients At Risk Of Developing LV Distention and Pu...mentioning

confidence: 99%

Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review

Yin

2023

Intensive Care Res

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“…Cardiopulmonary complications are often resultant of high left ventricular (LV) afterload, especially on prolonged ECMO (particularly VA-ECMO), which can lead to pulmonary edema [21]. Other cardiac sequelae include aortic valve regurgitation, biventricular failure, and LV thrombus which have been treated with a variety of modalities including intra-aortic balloon pump (IABP) and other percutaneous and surgical procedures to shunt elevated LV pressures [24]. Additional lung complications significantly associated with ECMO include pulmonary hemorrhage, hemorrhagic pulmonary infarct, pulmonary calcifications, and fibrinous pleuritis [18].…”

Section: Cardiopulmonary Complicationsmentioning

confidence: 99%

Nursing Implications in the ECMO Patient

Botsch¹,

Protain²,

Smith³

et al. 2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Effective care and positive outcomes of the extracorporeal membrane oxygenation (ECMO) patient necessitate optimal interdisciplinary management from the healthcare team, including expert care from specially trained registered nurses (RNs). It is incumbent upon the RN caring for the ECMO patient to excel in both time management and assessment skills, as this population often demands care delivery at the pinnacle of intensive care unit (ICU) acuity. Astute and nuanced monitoring of neurological status, bleeding risk with potential (often massive) transfusions, poor hemodynamics, and integrity of the ECMO pump itself are only the few specialized areas of focus that must share priority with traditional nursing considerations involving the critically ill, such as prevention of pressure injuries and bloodstream infections. These high-intensity medical foci must be balanced with ethical considerations, as the ultimate goal of returning the patient to their normal life is not always possible. These demands highlight the dynamic proficiency of the RN caring for the ECMO patient. The following chapter will highlight the importance of specialized nursing care in the critically ill patient supported with ECMO.

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Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

Xie¹,

Forrest²,

Loforte³

2019

Ann. Cardiothorac. Surg.

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Background: Despite the survival benefit of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for treatment of refractory cardiogenic shock, it can also have potentially deleterious effects of left ventricular overload and pulmonary edema. The objective of this review was to investigate the current evidence on the incidence, diagnosis, risk factors, prevention, and interventions for left ventricular overload in adult and pediatric VA-ECMO patients. Methods: Five electronic databases, including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews, were searched for original published studies from their dates of inception to January 2018. All types of adult and pediatric studies that investigated LV overload in VA-ECMO and were published in the English language were reviewed. Exclusion criteria included abstracts and conference presentations. Results: The reported incidence and sequelae of LV overload in VA-ECMO are highly variable, with presentations ranging from pulmonary arterial diastolic pressures of greater than 25 mmHg and LV distention on echocardiography, to severe pulmonary edema, LV thrombosis, and refractory ventricular arrhythmias. Currently, there are no standardized diagnostic criteria or guidelines for the type and timing of intervention for LV overload. Techniques for LV decompression have included direct surgical LV venting with catheter insertion via sternotomy or a minimally invasive incision; percutaneous catheterization via a transaortic, transseptal, or transpulmonary approach; ventricular assist devices; and intra-aortic balloon pumps. Conclusions: Left ventricular volume distention is a significant problem in VA-ECMO patients, with sequelae including myocardial ischemia, severe pulmonary edema, and intracardiac thrombosis. Further research is required on its incidence, diagnostic criteria, and risk factors, as well as the optimal timing and method for LV decompression, given the diversity of surgical and percutaneous techniques that are available.

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Left heart decompression in patients supported with extracorporeal membrane oxygenation for cardiac disease

Cited by 3 publications

References 10 publications

Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review

Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review

Nursing Implications in the ECMO Patient

Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

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