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

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

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)119-134
Number of pages16
JournalLung
Volume201
Issue number2
DOIs
StatePublished - Apr 2023

Keywords

  • Extracorporeal membrane oxygenation
  • Left ventricular unloading
  • Pulmonary edema
  • Pulmonary hemorrhage

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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