Left Ventricular Decompression in VA-ECMO: Analysis of Techniques and Outcomes

Welker, Carson C.; Huang, Jeffrey; Boswell, Michael R.; Spencer, Philip; Theoduloz, Mauricio A. Villavicencio; Ramakrishna, Harish

doi:10.1053/j.jvca.2022.07.024

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…Increased CVP can, in turn, aggravate pulmonary vascular resistance, cause interstitial edema, further increase airway resistance, decrease SaO 2 , and form a hemodynamic vicious circle. ECMO-assisted diversion can effectively reduce pulmonary hypertension and blood perfusion pressure in new lungs, stabilize patients’ blood circulation system, and reduce perioperative cardiac failure ( 29 , 33 , 34 ). Salman reported that routine prophylactic application of ECMO support during lung transplantation for patients with primary pulmonary hypertension can reduce perioperative mortality and improve cardiac function recovery 1 year after surgery ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

A risk score for predicting extracorporeal membrane oxygenation support before lung transplantation

Zhang,

Li,

Xie

et al. 2024

J Thorac Dis

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Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used as life support for lung transplantation. However, there are no clinical risk models to predict whether ECMO support is required for lung transplantation. This study developed a simple risk score to predict the need for intraoperative ECMO in patients undergoing lung transplantation, identify high-risk patients who need ECMO support, and guide clinical interventions. Methods Patients, who underwent lung transplantation between January 1, 2016 and July 31, 2021, were systematically reviewed. All enrolled patients were divided in a ratio of 7:3 to establish the development and validation datasets. A risk score model was established using stepwise logistic regression and verified using bootstrapping and the split-sample method. Results A total of 248 patients who underwent lung transplants were enrolled. Multivariate analysis showed that the primary disease diagnosis, pulmonary artery systolic pressure, sex, surgical type, creatine kinase isoenzyme-MB, and pro-B-type natriuretic peptide were risk factors for intraoperative ECMO during lung transplantation. The risk score was established and calibrated according to these six factors, ranging from 0 to 41, with the associated prediction of intraoperative use of ECMO ranging from 1.5% to 99.7% (Hosmer-Lemeshow χ 2 =5.624; P=0.689). Good discrimination was verified by developing and validating the datasets (C-statistics =0.850 and 0.842, respectively). Based on the distribution of the scores, the three levels were classified as low-risk (0–10], moderate-risk (10–20], and high-risk (20–41]. Conclusions This simple risk score model effectively predicts the need for intraoperative ECMO and stratifies high-risk patients who require ECMO support.

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Section: Discussionmentioning

confidence: 99%

A risk score for predicting extracorporeal membrane oxygenation support before lung transplantation

Zhang,

Li,

Xie

et al. 2024

J Thorac Dis

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“…One important complication that arises during peripheral VA-ECMO application is left ventricular distention (LVD), with an incidence ranging from 10% to 60% [ 96 ]. Due to retrograde aortic flow facilitated by peripheral VA-ECMO, left ventricular afterload is further increased along with wall stress, leading to left ventricular dilatation, elevated left atrial pressure, and pulmonary edema.…”

Section: Ecmo-related Complicationsmentioning

confidence: 99%

Clinical Application of Extracorporeal Membrane Oxygenation in the Treatment of Fulminant Myocarditis

Fan,

Wen,

et al. 2024

Rev. Cardiovasc. Med.

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Fulminant myocarditis (FM) is a rare but serious clinical syndrome which can be characterized by the rapid deterioration of cardiac function, with cardiogenic shock (CS) and arrhythmic electrical storms being common presentations, often requiring adjunctive support with mechanical circulatory devices. With the development of mechanical circulatory support (MCS) devices, there are now more and more studies investigating the application of MCS in FM patients, and the use of extracorporeal membrane oxygenation (ECMO) to treat FM has shown good survival rates. This review elucidates the treatment of FM, and the application and clinical outcomes associated with ECMO intervention.

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“…I read with great interest the recent expert review in which the authors discussed left ventricular (LV) decompression strategies in patients supported by venoarterial extracorporeal membrane oxygenation (ECMO). 1 Left ventricular decompression is essential for the prevention of increased LV pressure with ensuing stasis, left atrial distention, pulmonary edema, pulmonary hemorrhage, ventricular arrhythmias, and LV and aortic root clot formation. 2 The LV venting strategies vary by institution, but usually begin with modification of ECMO flows, pharmacologic interventions on preload, contractility and afterload, and changes in positive end-expiratory pressure.…”

mentioning

confidence: 99%

Intra-aortic balloon pump as a vent in VA-ECMO; lower risk, but beware

Ortoleva

2022

Journal of Cardiothoracic and Vascular Anesthesia

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Left Ventricular Decompression in VA-ECMO: Analysis of Techniques and Outcomes

Cited by 7 publications

References 34 publications

A risk score for predicting extracorporeal membrane oxygenation support before lung transplantation

A risk score for predicting extracorporeal membrane oxygenation support before lung transplantation

Clinical Application of Extracorporeal Membrane Oxygenation in the Treatment of Fulminant Myocarditis

Intra-aortic balloon pump as a vent in VA-ECMO; lower risk, but beware

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