Trans-diaphragmatic left ventricular venting during peripheral venous-arterial extracorporeal membrane oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) has proven to be an invaluable method of cardiopulmonary support in cases of severe cardiogenic shock. In an emergency, femoral artery and vein cannulation is the easiest and quickest access to initiate support. Often, with peripheral venous-arterial ECMO (VA ECMO), an inadequate reduction in left ventricular end-diastolic pressure (LVEDP) is present secondary to increased afterload from retrograde flow, inadequate RV drainage or persistent bronchial circulation. Elevated LVEDP has been known to be associated with poor myocardial recovery, LV thrombus formation and significant pulmonary edema. A cannulation strategy to achieve partial ventricular unloading is of paramount importance when considering ECMO support following cardiogenic shock to increase the potential for myocardial recovery. We present a novel case of emergent peripheral VA ECMO cannulation with a trans-diaphragmatic left ventricular (LV) vent in a 61-year-old, 79 kg male with end-stage liver disease and hepatitis B cirrhosis who suffered cardiac arrest during orthotopic liver transplantation.

Left ventricular thrombus formation in patients undergoing femoral veno-arterial extracorporeal membrane oxygenation

“…Different surgical techniques have been described to decompress the LV, including the application of a direct pulmonary venous vent or transapical cannulation. 8,21 Another surgical option to successfully unload the ventricle is the early transition to an axillary or central cannulation or the implementation of a long-term mechanical device. However, a central cannulation or a long-term mechanical device requires a thoracotomy or a sternotomy for cannulae placement.…”

Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life support: a Review of the Current Literature

“…Finally, Eudailey et al reported a singular approach characterized by cannulation with a transdiaphragmatic LV venting …”

Extracorporeal Membrane Oxygenation use on Liver Transplantation: An Integrative Review

“…Eight articles indicated the use of intraoperative ECMO, with two major subgroups as indications: the repercussion of previously diagnosed conditions or complications after severe post-reperfusion syndrome (Table 3). 20 Case report Post-reperfusion cardiogenic shock.…”