TY - JOUR
T1 - Unloading the Left Ventricle in Venoarterial ECMO
T2 - In Whom, When, and How?
AU - Ezad, Saad M.
AU - Ryan, Matthew
AU - Donker, Dirk W.
AU - Pappalardo, Federico
AU - Barrett, Nicholas
AU - Camporota, Luigi
AU - Price, Susanna
AU - Kapur, Navin K.
AU - Perera, Divaka
N1 - Funding Information:
This work was supported by funding from the British Heart Foundation (FS/CRTF/21/24118), National Institute for Health Research (NIHR130593), and National Institutes for Health (R01HL139785-01), as well as from the King’s Health Partners Cardiovascular and Respiratory Partnership clinical academic innovation fund.
Publisher Copyright:
© 2023 American Heart Association, Inc.
PY - 2023/4/18
Y1 - 2023/4/18
N2 - Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.
AB - Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Heart Ventricles/diagnostic imaging
KW - Heart-Assist Devices/adverse effects
KW - Humans
KW - Myocardium
KW - Shock, Cardiogenic/therapy
KW - heart failure
KW - heart-assist devices
KW - shock, cardiogenic
KW - myocardial infarction
KW - shock
KW - hemodynamics
KW - extracorporeal membrane oxygenation
UR - http://www.scopus.com/inward/record.url?scp=85152684915&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.122.062371
DO - 10.1161/CIRCULATIONAHA.122.062371
M3 - Article
C2 - 37068133
SN - 0009-7322
VL - 147
SP - 1237
EP - 1250
JO - Circulation
JF - Circulation
IS - 16
ER -