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Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm

  • EXTRACORPOREAL MEMBRANE OXYGENATION
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Abstract

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults for refractory cardiogenic shock has risen exponentially during the prior decade. Although VA-ECMO provides cardiopulmonary support, it can alter left ventricular (LV) loading conditions leading to LV distension, which makes the lungs susceptible to congestion and promotes intracardiac thrombosis. These conditions can be alleviated by pharmacologic and mechanical unloading, but gaps in knowledge remain on optimal timing and methods of this approach. This review provides an overview of the epidemiology of VA-ECMO, describes pathophysiology and methods for monitoring and reducing LV loading and summarizes contemporary studies examining the association between LV unloading and adverse events. We offer a simple protocol for implementing LV unloading during VA-ECMO to provide pulmonary protection and improve outcomes.

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Abbreviations

VA-ECMO:

Venoarterial Extracorporeal Membrane Oxygenation Support

LV:

Left ventricular

ELSO:

Extracorporeal Life Support Organization

LVAD:

Left Ventricular Assist Device

PCWP:

Pulmonary capillary wedge pressure

IABP:

Intraaortic Balloon Pump

pVAD:

Percutaneous ventricular assist device

PAC:

Pulmonary Artery Catheter

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Funding

O.S. is supported by the National Institutes of Health/National Heart, Lung and Blood Institute (K23HL145140). National Institutes of Health, NIH145140.

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  1. Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10023, USA

    Omar Saeed, Jose I. Nunez & Ulrich P. Jorde

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O.S. and K.N. drafted the manuscript. U.P. revised the manuscript and provided critical feedback. All authors have reviewed the manuscript.

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Saeed, O., Nunez, J.I. & Jorde, U.P. Pulmonary Protection from Left Ventricular Distension During Venoarterial Extracorporeal Membrane Oxygenation: Review and Management Algorithm. Lung 201, 119–134 (2023). https://doi.org/10.1007/s00408-023-00616-8

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