Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

doi:10.3877/cma.j.issn.2096-1537.2020.02.005

Abstract

Abstract:

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) provides complete circulatory support for patients with refractory cardiogenic shock and has been increasingly used in clinical practice. However, V-A ECMO using peripheral cannulation significantly increases the left ventricular afterload, results in many adverse consequences associated with left ventricular distension such as left ventricular enlargement, thrombosis, myocardial ischemia aggravation, refractory arrhythmia, and pulmonary edema, and is not conducive to the recovery of cardiac function. Therefore, in recent years, researchers have paid more and more attention to the investigation and application of left ventricular decompression. The present paper reviews various strategies for noninvasive and invasive left ventricular decompression in V-A ECMO.

Key words: Veno arterial extracorporeal membrane oxygenation, Ventricular dysfunction, left, Decompression

Shaosong Xi, Ying Zhu, Wei Hu. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(02): 132-139.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2020.02.005

https://icu.cma-cmc.com.cn/EN/Y2020/V06/I02/132

Figures/Tables 4

References 41

1	Kawashima D, Gojo S, Nishimura T, et al. Left ventricular mechanical support with impella provides more ventricular unloading in heart failure than extracorporeal membrane oxygenation[J]. ASAIO J, 2011, 57(3): 169-176.
2	Makdisi G, Hashmi ZA, Wozniak TC, et al. Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation[J]. J Thorac Dis, 2015, 7(11): E552-E554.
3	Lim HS, Howell N, Ranasinghe A. Extracorporeal Life Support: Physiological Concepts and Clinical Outcomes[J]. J Card Fail, 2017, 23(2): 181-196.
4	Cheng A, Swartz MF, Massey HT. Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation[J]. ASAIO J, 2013, 59(5): 533-536.
5	Meani P, Gelsomino S, Natour E, et al. Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life support: a Review of the Current Literature[J]. Eur J Heart Fail, 2017, 19(S2): 84-91.
6	Ostadal P, Mlcek M, Kruger A, et al. Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock[J]. J Transl Med, 2015, 13: 266.
7	Mirabel M, Luyt CE, Leprince P, et al. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support[J]. Crit Care Med, 2011, 39(5): 1029-1035.
8	Boulate D, Luyt CE, Pozzi M, et al. Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem[J]. Eur J Cardiothorac Surg, 2013, 44(3): 544-549.
9	Truby LK, Takeda K, Mauro C, et al. Incidence and Implications of Left Ventricular Distention During Venoarterial Extracorporeal Membrane Oxygenation Support[J]. ASAIO J, 2017, 63(3): 257-265.
10	Rupprecht L, Flörchinger B, Schopka S, et al. Cardiac decompression on extracorporeal life support: a review and discussion of the literature[J]. ASAIO J, 2013, 59(6): 547-553.
11	Cevasco M, Takayama H, Ando M, et al. Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation[J]. J Thorac Dis, 2019, 11(4): 1676-1683.
12	Werdan K, Gielen S, Ebelt H, et al. Mechanical circulatory support in cardiogenic shock[J]. Eur Heart J, 2014, 35(3): 156-167.
13	Extracorporeal Life support organization. ELSO Guidelines for cardiopulmonary extracorporeal life support (version 1.4)[EB/OL]. 2017-08.
14	Schmidt M, Bailey M, Kelly J, et al. Impact of fluid balance on outcome of adult patients treated with extracorporeal membrane oxygenation[J]. Intensive Care Med, 2014, 40(9): 1256-1266.
15	Landes E, Truby L, Mundy L, et al. Partial flow with 15f arterial cannula provides sufficient circulatory support in Veno-Arterial extracorporeal membrane oxygenation[J]. J Heart Lung Transplant, 2014, 33(4): S250-S250.
16	Donker DW, Brodie D, Henriques JPS, et al. Left ventricular unloading during veno-arterial ECMO: a simulation study[J]. ASAIO J, 2019, 65(1): 11-20.
17	Burkhoff D, Sayer G, Doshi D, et al. Hemodynamics of mechanical circulatory support[J]. J Am Coll Cardiol, 2015, 66(23): 2663-2674.
18	Rastan AJ, Dege A, Mohr M, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock[J]. Thorac Cardiovasc Surg, 2010, 139(2): 302-311.
19	Ro SK, Kim JB, Jung SH, et al. Extracorporeal life support for cardiogenic shock: influence of concomitant intra-aortic balloon counterpulsation[J]. Eur J Cardiothorac Surg, 2014, 46(2): 186-192.
20	Belohlavek J, Mlcek M, Huptych M, et al. Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation[J]. Crit Care, 2012, 16(2): R50.
21	Urschel CW, Eber L, Forrester J, et al. Alteration of mechanical performance of the ventricle by intraaortic balloon counterpulsation[J]. Am J Cardiol, 1970, 25(5): 546-551.
22	Alhussein M, Moayedi Y, Posada JD, et al. Ventricular thrombosis post-venoarterial extracorporeal membrane oxygenation[J]. Circ Heart Fail, 2017, 10(2): e003757
23	Petroni T, Harrois A, Amour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation[J]. Crit Care Med, 2014,42(9): 2075-2082.
24	Brechot N, Demondion P, Santi F, et al. Intra-aortic balloon pump protects against hydrostatic pulmonary edema during peripheral venoarterial-extracorporeal membrane oxygenation[J]. Eur Heart J Acute Cardiovasc Care, 2018, 7(1): 62-69.
25	Watanabe S, Fish K, Kovacic JC, et al. Left ventricular unloading using an impella cp improves coronary flow and infarct zone perfusion in ischemic heart failure[J]. J Am Heart Assoc, 2018, 7(6): e006462.
26	Koeckert MS, Jorde UP, Naka Y, et al. Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support[J]. J Card Surg, 2011, 26(6): 666-668.
27	Pappalardo F, Schulte C, Pieri M, et al. Concomitant implantation of Impella(R) on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock[J]. Eur J Heart Fail, 2017, 19(3): 404-412.
28	Lim HS. The Effect of Impella CP on Cardiopulmonary Physiology During Venoarterial Extracorporeal Membrane Oxygenation Support[J]. Artif Organs, 2017, 41(12): 1109-1112.
29	Ouweneel DM, Henriques JPS. Percutaneous cardiac support devices for cardiogenic shock: current indications and recommendations[J]. Heart, 2012, 98(16): 1246-1254.
30	Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock[J]. Eur Heart J, 2005, 26(13): 1276-1283
31	Kar B, Gregoric ID, Basra SS, et al. The percutaneous ventricular assist device in severe refractory cardiogenic shock[J]. J Am Coll Cardiol, 2011, 57(6): 688-696.
32	Burkhoff D, Cohen H, Brunckhorst C, et al. TandemHeart Investigators Group. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device vs. conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock[J]. Am Heart J, 2006, 152(3): 469.e1-469.e8.
33	Kotani Y, Chetan D, Rodrigues W, et al. Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: current strategy and clinical outcomes[J]. Artif Organs, 2013, 37(1): 29-36.
34	Baruteau AE, Barnetche T, Morin L, et al. Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression[J]. Eur Heart J Acute Cardiovasc Care, 2018, 7(1): 70-79.
35	Veeram Reddy SR, Guleserian KJ, et al. Transcatheter removal of atrial septal stent placed to decompress left atrium with VA ECMO[J]. Catheter Cardiovasc Interv, 2015, 85(6): 1021-1025.
36	Alkhouli M, Narins CR, Lehoux J, et al. Percutaneous Decompression of the Left Ventricle in Cardiogenic Shock Patients on Venoarterial Extracorporeal Membrane Oxygenation[J]. J Card Surg, 2016, 31(3): 177-182.
37	Barbone A, Malvindi PG, Ferrara P, et al. Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation[J]. Interact Cardiovasc Thorac Surg, 2011, 13(3): 293-295.
38	Fumagalli R, Bombino M, Borelli M, et al. Percutaneous bridge to heart transplantation by venoarterial ECMO and transaortic left ventricular venting[J]. Int J Artif Organs, 2004, 27(5): 410-413.
39	Aiyagari RM, Rocchini AP, Remenapp RT, et al. Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit[J]. Crit Care Med, 2006, 34(10): 2603-2606.
40	Sidebotham D, Allen S, McGeorge A, et al. Catastrophic left heart distension following initiation of venoarterial extracorporeal membrane oxygenation in a patient with mild aortic regurgitation[J]. Anaesth Intensive Care, 2012, 40(3): 568-569.
41	Tepper S, Masood MF, Baltazar Garcia M, et al. Left ventricular unloading by Impella device versus surgical vent during extracorporeal life support[J]. Ann Thorac Surg, 2017, 104(3): 861-867.

[1]	Qiang Sun, Xiaozhong Guo, Randong Wang, Bing Li, Ju′an Yue, Wangyan Liu, Jiao Chen. Effect analysis of double channel decompression and bone grafting plus structural bone support in the treatment of early osteonecrosis of the femoral head [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(06): 490-495.
[2]	Zhengrong Yan, Dan Bai, Xiangzhi Qin, Dongbing Zhou, Mingyang Ren, Quanlin Li. Endoscopic stent decompression versus stoma decompression on short- and long-term efficacy as a bridge to elective resection for obstructive colorectal cancer: A meta-analysis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 75-80.
[3]	Kaiyu Jian, Lin Jiang, Qianru Xu, Xin Lu, Yonggui Fu, Feng Liang. Application of a new type of anastomotic decompression and drainage device in laparoscopic anal preservation surgery for rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(02): 209-212.
[4]	Haining Tan, Lingjia Yu, Xuehu Xie, Ning Liu, Guoqiang Zhang, Xiang Li, Yong Yang, Bin Zhu. Hidden blood loss and risk factors of uniportal full-endoscopic decompression for lumbar spinal stenosis [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(04): 233-238.
[5]	Xiaoyu Fan, Sizheng Sun, Yimin E, Chunzhao Yu. Different surgical options for obstructive left colon cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(06): 500-504.
[6]	Lihua Chen, Yong Xia, Hongzhi Huang, Fan Wei, Kai Sun, Wenjin Chen, Ruxiang Xu. Effect of anterior clinoid process osteotomy and optic canal opening on the treatment of anterior clinoid meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(03): 142-148.
[7]	Hong Tang, Ling Gao, Ning Gao, Junwen Jiang, Jikun Zhang, You Li, Weiming Chen, Ying Xia. Application of controlled decompression in the treatment of severe traumatic brain injury [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(02): 91-96.
[8]	Yongnan Wang, Qihong Wang, Jie Yin, Chunying Ou. Preliminary study of keyhole craniotomy for microvascular decompression in the treatment of vestibular paroxysmia [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(01): 43-47.
[9]	Li Zhang. Peripheral neuropathic pain and peripheral nerve decompression [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(01): 1-6.
[10]	Hongxiang Ren, Li Zhang, Yulian Zhang, Xuelai Liu, Yanbing Yu. Application value of brainstem auditory evoked potential in microvascular decompression of facial spasm [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(02): 87-91.
[11]	Yigong Wei, Kun Zhou, Guangtang Chen, Cheng Wang, Chuangxi Liu. Clinical analysis of modified stepwise decompression technique combined with decompressive craniectomy under intracranial pressure monitoring to treat high intracranial pressure [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(01): 28-33.
[12]	Lihua Chen, Yong Xia, Fan Wei, Kai Sun, Hongzhi Huang. Study on the factors influencing postoperative visual acuity of anterior clinoid meningioma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(06): 332-337.
[13]	Lei Shu, Shigang Lyu, Zuyu Cheng, Juexian Xiao, Kai Huang, Xiaoyan Su. Effect of posterior fossa decompression on craniovertebral junction stability in the treatment of Chiari type I malformation [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(06): 343-348.
[14]	Sadike Maihaba·, Qixia Zhao, Yan Xiao. Meta-analysis of lower extremity peripheral nerve decompression and conventional drugs in patients with painful diabetic peripheral neuropathy [J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(03): 174-180.
[15]	Pengfei Shi, Changwei Wang, Yazhou Guo, Xiao Liu, Kai Li, Yu Liu, Bing He, Yutao Zhao, Dezhong Liu. Efficacy and safety of percutaneous balloon compression and microvascular decompression in the treatment of trigeminal neuralgia in the elderly [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(04): 258-262.

Please choose a citation manager

Content to export