Issues on left ventricular decompression during veno-arterial extracorporeal membrane oxygenation in cardiogenic shock patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Yangbo ,  GAN Changping

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

GAN Changping, Email: ganchangping@hotmail.com

Keywords：

Extracorporeal membrane oxygenation; veno-arterial extracorporeal membrane oxygenation; left ventricular decompression; review

DOI：

10.7507/1007-4848.202011090

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Although extracorporeal membrane oxygenation (ECMO) has been in existence since the 1970s as a means of supporting respiratory or cardiac function, early application of this technology was plagued by high complication rates. Peripheral veno-arterial extracorporeal membrane oxygenation (V-A ECMO) causes higher left ventricular end-diastolic pressure, pulmonary edema, left ventricular distention, ventricular arrhythmia, low coronary perfusion, myocardial ischemia, substantial thrombus formation within left ventricule cavity and even multiple organ dysfunction. Mechanical left ventricular decompression is required to treat these related complications. In this article, we reviewed the problems associated with left ventricular decompression supported by peripheral V-A ECMO in patients with cardiogenic shock.

Citation： YAN Yangbo, GAN Changping. Issues on left ventricular decompression during veno-arterial extracorporeal membrane oxygenation in cardiogenic shock patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1114-1118. doi: 10.7507/1007-4848.202011090 Copy

1.	Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol, 2014, 63(25 Pt A): 2769-2778.
2.	Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults: JACC scientific expert panel. J Am Coll Cardiol, 2019, 73(6): 698-716.
3.	Weymann A, Schmack B, Sabashnikov A, et al. Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. J Cardiothorac Surg, 2014, 9: 60.
4.	Rao P, Khalpey Z, Smith R, et al. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail, 2018, 11(9): e004905.
5.	Vallabhajosyula S, Dunlay SM, Prasad A, et al. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. J Am Coll Cardiol, 2019, 73(14): 1781-1791.
6.	Lemaire A, Anderson MB, Lee LY, et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg, 2014, 97(1): 133-138.
7.	van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation, 2017, 136(16): e232-e268.
8.	Ro SK, Kim WK, Lim JY, et al. Extracorporeal life support for adults with refractory septic shock. J Thorac Cardiovasc Surg, 2018, 156(3): 1104-1109.
9.	Maclaren G, Butt W, Best D, et al. Extracorporeal membrane oxygenation for refractory septic shock in children: One institution's experience. Pediatr Crit Care Med, 2007, 8(5): 447-451.
10.	Hoeper MM, Tudorache I, Kühn C, et al. Extracorporeal membrane oxygenation watershed. Circulation, 2014, 130(10): 864-865.
11.	Gehron J, Schuster M, Rindler F, et al. Watershed phenomena during extracorporeal life support and their clinical impact: A systematic in vitro investigation. ESC Heart Fail, 2020, 7(4): 1850-1861.
12.	Schrage B, Burkhoff D, Rübsamen N, et al. Unloading of the left ventricle during venoarterial extracorporeal membrane oxygenation therapy in cardiogenic shock. JACC Heart Fail, 2018, 6(12): 1035-1043.
13.	Burkhoff D, Sayer G, Doshi D, et al. Hemodynamics of mechanical circulatory support. J Am Coll Cardiol, 2015, 66(23): 2663-2674.
14.	Boulate D, Luyt CE, Pozzi M, et al. Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: An unrecognized problem. Eur J Cardiothorac Surg, 2013, 44(3): 544-549.
15.	Lee HE, Yi ES, Rabatin JT, et al. Histopathologic findings in lungs of patients treated with extracorporeal membrane oxygenation. Chest, 2018, 153(4): 825-833.
16.	Kato J, Seo T, Ando H, et al. Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg, 1996, 111(3): 630-636.
17.	Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res, 1959, 7(4): 649-657.
18.	Rupprecht L, Flörchinger B, Schopka S, et al. Cardiac decompression on extracorporeal life support: A review and discussion of the literature. ASAIO J, 2013, 59(6): 547-553.
19.	Donker DW, Brodie D, Henriques JPS, et al. Left ventricular unloading during veno-arterial ECMO: A review of percutaneous and surgical unloading interventions. Perfusion, 2019, 34(2): 98-105.
20.	Schibilsky D, Kruger T, Lausberg HF, et al. Impella 5.0 as a second-line mechanical circulatory support strategy after extracorporeal life support. Artif Organs, 2016, 40(9): 909-916.
21.	Tschöpe C, Van Linthout S, Klein O, et al. Mechanical unloading by fulminant myocarditis: LV-Impella, Ecmella, BI-Pella, and Propella concepts. J Cardiovasc Transl Res, 2019, 12(2): 116-123.
22.	Petroni T, Harrois A, Amour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Crit Care Med, 2014, 42(9): 2075-2082.
23.	Yamamoto M, Oshima Y, Matsuhisa H, et al. Left atrial decompression by minithoracotomy during extracorporeal life support. Ann Thorac Surg, 2019, 107(3): e227-e228.
24.	Akanni OJ, Takeda K, Truby LK, et al. EC-VAD: Combined use of extracorporeal membrane oxygenation and percutaneous microaxial pump left ventricular assist device. ASAIO J, 2019, 65(3): 219-226.
25.	Patel SM, Lipinski J, Al-Kindi SG, et al. Simultaneous venoarterial extracorporeal membrane oxygenation and percutaneous left ventricular decompression therapy with impella is associated with improved outcomes in refractory cardiogenic shock. ASAIO J, 2019, 65(1): 21-28.
26.	Prasad A, Ghodsizad A, Brehm C, et al. Refractory pulmonary edema and upper body hypoxemia during veno-arterial extracorporeal membrane oxygenation — a case for atrial septostomy. Artif Organs, 2018, 42(6): 664-669.
27.	Russo JJ, Aleksova N, Pitcher I, et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J Am Coll Cardiol, 2019, 73(6): 654-662.
28.	Rastan AJ, Tillmann E, Subramanian S, et al. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation, 2010, 122(11 Suppl): S92-S99.
29.	Sjauw KD, Engström AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: Should we change the guidelines? Eur Heart J, 2009, 30(4): 459-468.
30.	Lauten A, Engström AE, Jung C, et al. Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: Results of the Impella-EUROSHOCK-registry. Circ Heart Fail, 2013, 6(1): 23-30.
31.	Pieri M, Contri R, Winterton D, et al. The contemporary role of Impella in a comprehensive mechanical circulatory support program: A single institutional experience. BMC Cardiovasc Disord, 2015, 15: 126.
32.	Camboni D, Schmid C. To vent or not on veno-arterial extracorporeal membrane oxygenation, does it improve myocardial recovery and outcome? J Thorac Dis, 2017, 9(12): 4915-4918.
33.	Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg, 2019, 8(1): 9-18.
34.	Meani P, Gelsomino S, Natour E, et al. Modalities and effects of left ventricle unloading on extracorporeal life support: A review of the current literature. Eur J Heart Fail, 2017, 19 (Suppl 2): 84-91.
35.	尚小珂, 柳梅, 张长东, 等. 中国首例难治性心力衰竭 ECMO 辅助患者经皮超声引导心房分流器植入. 中国胸心血管外科临床杂志, 2020, 27(12): 1502-1504.
36.	Cheng R, Hachamovitch R, Kittleson M, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1, 866 adult patients. Ann Thorac Surg, 2014, 97(2): 610-616.
37.	Truby LK, Takeda K, Mauro C, et al. Incidence and implications of left ventricular distention during venoarterial extracorporeal membrane oxygenation support. ASAIO J, 2017, 63(3): 257-265.
38.	Cheng A, Swartz MF, Massey HT. Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation. ASAIO J, 2013, 59(5): 533-536.
39.	Kotani Y, Chetan D, Rodrigues W, et al. Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: Current strategy and clinical outcomes. Artif Organs, 2013, 37(1): 29-36.
40.	Zampi JD, Alghanem F, Yu S, et al. Relationship between time to left atrial decompression and outcomes in patients receiving venoarterial extracorporeal membrane oxygenation support: A multicenter Pediatric Interventional Cardiology Early-Career Society study. Pediatr Crit Care Med, 2019, 20(8): 728-736.
41.	Sandrio S, Springer W, Karck M, et al. Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output. Cardiol Young, 2014, 24(4): 654-660.
42.	Alghanem F, Balasubramanian S, Zampi JD. Impact of left atrial decompression on patient outcomes during pediatric venoarterial extracorporeal membrane oxygenation: A case-control study. Pediatr Cardiol, 2019, 40(6): 1266-1274.
43.	Na SJ, Yang JH, Yang JH, et al. Left heart decompression at venoarterial extracorporeal membrane oxygenation initiation in cardiogenic shock: Prophylactic versus therapeutic strategy. J Thorac Dis, 2019, 11(9): 3746-3756.

1. Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol, 2014, 63(25 Pt A): 2769-2778.
2. Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults: JACC scientific expert panel. J Am Coll Cardiol, 2019, 73(6): 698-716.
3. Weymann A, Schmack B, Sabashnikov A, et al. Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. J Cardiothorac Surg, 2014, 9: 60.
4. Rao P, Khalpey Z, Smith R, et al. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest. Circ Heart Fail, 2018, 11(9): e004905.
5. Vallabhajosyula S, Dunlay SM, Prasad A, et al. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. J Am Coll Cardiol, 2019, 73(14): 1781-1791.
6. Lemaire A, Anderson MB, Lee LY, et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg, 2014, 97(1): 133-138.
7. van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation, 2017, 136(16): e232-e268.
8. Ro SK, Kim WK, Lim JY, et al. Extracorporeal life support for adults with refractory septic shock. J Thorac Cardiovasc Surg, 2018, 156(3): 1104-1109.
9. Maclaren G, Butt W, Best D, et al. Extracorporeal membrane oxygenation for refractory septic shock in children: One institution's experience. Pediatr Crit Care Med, 2007, 8(5): 447-451.
10. Hoeper MM, Tudorache I, Kühn C, et al. Extracorporeal membrane oxygenation watershed. Circulation, 2014, 130(10): 864-865.
11. Gehron J, Schuster M, Rindler F, et al. Watershed phenomena during extracorporeal life support and their clinical impact: A systematic in vitro investigation. ESC Heart Fail, 2020, 7(4): 1850-1861.
12. Schrage B, Burkhoff D, Rübsamen N, et al. Unloading of the left ventricle during venoarterial extracorporeal membrane oxygenation therapy in cardiogenic shock. JACC Heart Fail, 2018, 6(12): 1035-1043.
13. Burkhoff D, Sayer G, Doshi D, et al. Hemodynamics of mechanical circulatory support. J Am Coll Cardiol, 2015, 66(23): 2663-2674.
14. Boulate D, Luyt CE, Pozzi M, et al. Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: An unrecognized problem. Eur J Cardiothorac Surg, 2013, 44(3): 544-549.
15. Lee HE, Yi ES, Rabatin JT, et al. Histopathologic findings in lungs of patients treated with extracorporeal membrane oxygenation. Chest, 2018, 153(4): 825-833.
16. Kato J, Seo T, Ando H, et al. Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg, 1996, 111(3): 630-636.
17. Guyton AC, Lindsey AW. Effect of elevated left atrial pressure and decreased plasma protein concentration on the development of pulmonary edema. Circ Res, 1959, 7(4): 649-657.
18. Rupprecht L, Flörchinger B, Schopka S, et al. Cardiac decompression on extracorporeal life support: A review and discussion of the literature. ASAIO J, 2013, 59(6): 547-553.
19. Donker DW, Brodie D, Henriques JPS, et al. Left ventricular unloading during veno-arterial ECMO: A review of percutaneous and surgical unloading interventions. Perfusion, 2019, 34(2): 98-105.
20. Schibilsky D, Kruger T, Lausberg HF, et al. Impella 5.0 as a second-line mechanical circulatory support strategy after extracorporeal life support. Artif Organs, 2016, 40(9): 909-916.
21. Tschöpe C, Van Linthout S, Klein O, et al. Mechanical unloading by fulminant myocarditis: LV-Impella, Ecmella, BI-Pella, and Propella concepts. J Cardiovasc Transl Res, 2019, 12(2): 116-123.
22. Petroni T, Harrois A, Amour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Crit Care Med, 2014, 42(9): 2075-2082.
23. Yamamoto M, Oshima Y, Matsuhisa H, et al. Left atrial decompression by minithoracotomy during extracorporeal life support. Ann Thorac Surg, 2019, 107(3): e227-e228.
24. Akanni OJ, Takeda K, Truby LK, et al. EC-VAD: Combined use of extracorporeal membrane oxygenation and percutaneous microaxial pump left ventricular assist device. ASAIO J, 2019, 65(3): 219-226.
25. Patel SM, Lipinski J, Al-Kindi SG, et al. Simultaneous venoarterial extracorporeal membrane oxygenation and percutaneous left ventricular decompression therapy with impella is associated with improved outcomes in refractory cardiogenic shock. ASAIO J, 2019, 65(1): 21-28.
26. Prasad A, Ghodsizad A, Brehm C, et al. Refractory pulmonary edema and upper body hypoxemia during veno-arterial extracorporeal membrane oxygenation — a case for atrial septostomy. Artif Organs, 2018, 42(6): 664-669.
27. Russo JJ, Aleksova N, Pitcher I, et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J Am Coll Cardiol, 2019, 73(6): 654-662.
28. Rastan AJ, Tillmann E, Subramanian S, et al. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation, 2010, 122(11 Suppl): S92-S99.
29. Sjauw KD, Engström AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: Should we change the guidelines? Eur Heart J, 2009, 30(4): 459-468.
30. Lauten A, Engström AE, Jung C, et al. Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: Results of the Impella-EUROSHOCK-registry. Circ Heart Fail, 2013, 6(1): 23-30.
31. Pieri M, Contri R, Winterton D, et al. The contemporary role of Impella in a comprehensive mechanical circulatory support program: A single institutional experience. BMC Cardiovasc Disord, 2015, 15: 126.
32. Camboni D, Schmid C. To vent or not on veno-arterial extracorporeal membrane oxygenation, does it improve myocardial recovery and outcome? J Thorac Dis, 2017, 9(12): 4915-4918.
33. Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg, 2019, 8(1): 9-18.
34. Meani P, Gelsomino S, Natour E, et al. Modalities and effects of left ventricle unloading on extracorporeal life support: A review of the current literature. Eur J Heart Fail, 2017, 19 (Suppl 2): 84-91.
35. 尚小珂, 柳梅, 张长东, 等. 中国首例难治性心力衰竭 ECMO 辅助患者经皮超声引导心房分流器植入. 中国胸心血管外科临床杂志, 2020, 27(12): 1502-1504.
36. Cheng R, Hachamovitch R, Kittleson M, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1, 866 adult patients. Ann Thorac Surg, 2014, 97(2): 610-616.
37. Truby LK, Takeda K, Mauro C, et al. Incidence and implications of left ventricular distention during venoarterial extracorporeal membrane oxygenation support. ASAIO J, 2017, 63(3): 257-265.
38. Cheng A, Swartz MF, Massey HT. Impella to unload the left ventricle during peripheral extracorporeal membrane oxygenation. ASAIO J, 2013, 59(5): 533-536.
39. Kotani Y, Chetan D, Rodrigues W, et al. Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: Current strategy and clinical outcomes. Artif Organs, 2013, 37(1): 29-36.
40. Zampi JD, Alghanem F, Yu S, et al. Relationship between time to left atrial decompression and outcomes in patients receiving venoarterial extracorporeal membrane oxygenation support: A multicenter Pediatric Interventional Cardiology Early-Career Society study. Pediatr Crit Care Med, 2019, 20(8): 728-736.
41. Sandrio S, Springer W, Karck M, et al. Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output. Cardiol Young, 2014, 24(4): 654-660.
42. Alghanem F, Balasubramanian S, Zampi JD. Impact of left atrial decompression on patient outcomes during pediatric venoarterial extracorporeal membrane oxygenation: A case-control study. Pediatr Cardiol, 2019, 40(6): 1266-1274.
43. Na SJ, Yang JH, Yang JH, et al. Left heart decompression at venoarterial extracorporeal membrane oxygenation initiation in cardiogenic shock: Prophylactic versus therapeutic strategy. J Thorac Dis, 2019, 11(9): 3746-3756.

Previous Article
Research progress on extracorporeal cardiopulmonary resuscitation
Next Article
Progress in surgical treatment of pectus excavatum

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Issues on left ventricular decompression during veno-arterial extracorporeal membrane oxygenation in cardiogenic shock patients

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content