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Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation
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Abstract
Objective: Our study investigates the frequency and determines the characteristics and outcomes of patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support requiring left ventricular unloading at Ha Noi Heart hospital.
Methods: A cross-sectional descriptive study was conducted among 84 patients undergoing VA- ECMO between December 2018 and December 2021 at Ha Noi Heart hospital. Signs of left ventricular distension in VA-ECMO (Inadequate arterial blood pressure pulsatility, “smoke like” effect in left ventricular, reduced aortic valve opening/absent aortic valve closure, pulmonary edema, left ventricular distension) were studied before and at 24 hours, 48 hours and 72 hours after VA-ECMO support.
Results: Left ventricular distention requiring decompression occurs in 44,1% of patients supported with VA-ECMO 3.6% (left ventricular distension), inadequate arterial blood pressure pulsatility (77,4%), “smoke like” effect in left ventricular (53,6%), pulmonary edema 47 ,6%; reduced aortic valve opening/absent aortic valve closure in 35,7% of the cases. Left ventricular decompression may improve clinical outcomes from 48 hours onwards (p<0.05). There were no differences in age, left ventricular ejection fraction before VA-ECMO, ECRP rates, continuous renal replacement therapy rates, duration of mechanical ventilation, duration of ECMO, hospital length of stay and diagnosis of patients with and without left ventricular unloading (p>0.05). The proportion of patients using invasive left ventricular decompression who successful weaning from VA- ECMO was significantly higher than in the group without left ventricular unloading (94,5% versus 74,4%; p<0.05).The survival rate of patients using left ventricular unloading tended to be higher than that in the group without left ventricular decompression (72,9% vs 53,2%; p>0.05) ). Complications of invasive left ventricular decompression included 1 patient with occlusion of the junction requires removal of the left atrial drainage.
Conclusion: Left heart decompression may contribute to increasing the success rate of VA-ECMO weaning and may help to improve the survival rate of patients with VA ECMO.
Article Details
Keywords
Left ventricular decompression, VA ECMO, left atrial drainage, left ventricular venting, IABP
References
2. Lorusso R, Shekar K, MacLaren G, et al. ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO Journal. 2021;67(8):827. doi:10.1097/MAT.0000000000001510
3. Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Annals of Cardiothoracic Surgery. 2019;8(1):98-18. doi:10.21037/acs.2018.11.07
4. Bộ Y Tế (2017) Hướng dẫn quy trình kỹ thuật nội khoa chuyên ngành tim mạch. (Quyết định 3983/QĐ-BYT quy trình kỹ thuật nội khoa chuyên ngành tim mạch của Bộ trưởng Bộ Y tế), Hà Nội
5. Rajsic S, Breitkopf R, Bukumiric Z, Treml B. ECMO Support in Refractory Cardiogenic Shock: Risk Factors for Mortality. Journal of Clinical Medicine. 2022;11(22):6821. doi:10.3390/jcm11226821
6. Cheng R, Hachamovitch R, Kittleson M, et al. Complications of Extracorporeal Membrane Oxygenation for Treatment of Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis of 1,866 Adult Patients. The Annals of Thoracic Surgery. 2014;97(2):610-616. doi:10.1016/j.athoracsur.2013.09.008
7. Truby LK, Takeda K, Mauro C, et al. Incidence and Implications of Left Ventricular Distention During Venoarterial Extracorporeal Membrane Oxygenation Support. ASAIO J. 2017;63(3):257-265. doi:10.1097/MAT.0000000000000553
8. Grandin EW, Nunez JI, Willar B, et al. Mechanical Left Ventricular Unloading in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation. Journal of the American College of Cardiology. 2022;79(13):1239-1250. doi:10.1016/j.jacc.2022.01.032
9. Chen K, Hou J, Tang H, Hu S. Concurrent Implantation of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock. Artif Organs. 2019;43(2):142-149. doi:10.1111/aor.13317
10. Bréchot N, Demondion P, Santi F, et al. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2018;7(1):62-69. doi:10.1177/2048872617711169
11. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63(25 Pt A):2769-2778. doi:10.1016/j.jacc.2014.03.046
12. Al-Fares AA, Randhawa VK, Englesakis M, et al. Optimal Strategy and Timing of Left Ventricular Venting During Veno-Arterial Extracorporeal Life Support for Adults in Cardiogenic Shock. Circulation: Heart Failure. 2019;12(11):e006486. doi:10.1161/CIRCHEARTFAILURE.119.006486
13. Delmas C, Vallee L, Bouisset F, et al. Use of Percutaneous Atrioseptotosmy for Left Heart Decompression During Veno‐Arterial Extracorporeal Membrane Oxygenation Support: An Observational Study. Journal of the American Heart Association. 2022;11(17):e024642. doi:10.1161/JAHA.121.024642
14. Kowalewski M, Malvindi PG, Zieliński K, et al. Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2020;9(4):1039. doi:10.3390/jcm9041039.