Left Ventricular Unloading During Extracorporeal Life Support: Current Practice.

Authors :: Rali AS
Hall EJ
Dieter R
Ranka S
Civitello A
Bacchetta MD
Shah AS
Schlendorf K
Lindenfeld J
Chatterjee S
Source :: Journal of cardiac failure [J Card Fail] 2022 Aug; Vol. 28 (8), pp. 1326-1336. Date of Electronic Publication: 2021 Dec 20.
Publication Year :: 2022
Abstract: Venoarterial extracorporeal life support (VA-ECLS) is a powerful tool that can provide complete cardiopulmonary support for patients with refractory cardiogenic shock. However, VA-ECLS increases left ventricular (LV) afterload, resulting in greater myocardial oxygen demand, which can impair myocardial recovery and worsen pulmonary edema. These complications can be ameliorated by various LV venting strategies to unload the LV. Evidence suggests that LV venting improves outcomes in VA-ECLS, but there is a paucity of randomized trials to help guide optimal strategy and the timing of venting. In this review, we discuss the available evidence regarding LV venting in VA-ECLS, explain important hemodynamic principles involved, and propose a practical approach to LV venting in VA-ECLS.<br />Competing Interests: Conflict of interest None.<br /> (Copyright © 2021 Elsevier Inc. All rights reserved.)

Subjects :: Heart Ventricles
Hemodynamics
Humans
Shock, Cardiogenic therapy
Extracorporeal Membrane Oxygenation methods
Heart Failure therapy

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