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ECMO-Extracorporeal Life Support in Adults pp 193–206Cite as

Left Ventricular Rest and Unloading During VA ECMO

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Abstract

Mechanical supports, such as ECMO, are aimed mostly to ensure organ perfusion during profound cardiogenic shock, but also adequate left ventricle (LV) rest, allowing recovery of stunned myocardium and relieving shear stress from the newly necrotic area. For a combination of severe myocardial dysfunction and the adjunctive afterload, due to retrograde flow from the arterial cannula and inadequate RV drainage and bronchial circulation, LV end-diastolic, left atrium, and pulmonary pressure could dangerously rise, causing progressive dilatation of the LV, remodeling and worse systolic performance, increased wall stress, and myocardial oxygen consumption. It is mandatory, therefore, to establish adequate LV decompression, to improve symptoms, such as pulmonary edema, hemoptysis, and pulmonary hemorrhages potentially leading to irreversible pulmonary failure. This goal may be achieved by means of optimal medical treatment (combination and careful titration of inotropes and vasopressors) and by mechanical decompression (IABP, different venting strategies, impeller axial pumps).

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Author information

Authors and Affiliations

  1. Cardiac Anesthesia and Intensive Care Unit, Department of Emergency Medicine, San Gerardo Hospital, University of Milano-Bicocca, Milan, Italy

    Gianluca Greco & Barbara Cortinovis

  2. Via Pergolesi 33, 20900, Monza, Italy

    Gianluca Greco & Barbara Cortinovis

  3. Cardiac Anesthesia and Intensive Care Unit, Department of Urgency and Emergency, San Gerardo Hospital, Via Pergolesi 33, Monza, (MB), 20900, Italy

    Leonello Avalli

Authors
  1. Gianluca Greco
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  2. Barbara Cortinovis
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  3. Leonello Avalli
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Correspondence to Gianluca Greco .

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza (MB), Italy

    Fabio Sangalli

  2. Department of Health Sciences Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza (MB), Italy

    Nicolò Patroniti

  3. Health Science Departement, Università Milano Bicocca Facoltà Medicina e Chirurgia, Monza (MB), Italy

    Antonio Pesenti

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Greco, G., Cortinovis, B., Avalli, L. (2014). Left Ventricular Rest and Unloading During VA ECMO. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_17

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  • DOI: https://doi.org/10.1007/978-88-470-5427-1_17

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  • Online ISBN: 978-88-470-5427-1

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