Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation

Abstract

Objective: Our study investigates the frequency and determines the characteristics and outcomes of patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support requiring left ventricular unloading at Ha Noi Heart hospital.
 Methods: A cross-sectional descriptive study was conducted among 84 patients undergoing VA- ECMO between December 2018 and December 2021 at Ha Noi Heart hospital. Signs of left ventricular distension in VA-ECMO (Inadequate arterial blood pressure pulsatility, “smoke like” effect in left ventricular, reduced aortic valve opening/absent aortic valve closure, pulmonary edema, left ventricular distension) were studied before and at 24 hours, 48 hours and 72 hours after VA-ECMO support.
 Results: Left ventricular distention requiring decompression occurs in 44,1% of patients supported with VA-ECMO 3.6% (left ventricular distension), inadequate arterial blood pressure pulsatility (77,4%), “smoke like” effect in left ventricular (53,6%), pulmonary edema 47 ,6%; reduced aortic valve opening/absent aortic valve closure in 35,7% of the cases. Left ventricular decompression may improve clinical outcomes from 48 hours onwards (p<0.05). There were no differences in age, left ventricular ejection fraction before VA-ECMO, ECRP rates, continuous renal replacement therapy rates, duration of mechanical ventilation, duration of ECMO, hospital length of stay and diagnosis of patients with and without left ventricular unloading (p>0.05). The proportion of patients using invasive left ventricular decompression who successful weaning from VA- ECMO was significantly higher than in the group without left ventricular unloading (94,5% versus 74,4%; p<0.05).The survival rate of patients using left ventricular unloading tended to be higher than that in the group without left ventricular decompression (72,9% vs 53,2%; p>0.05) ). Complications of invasive left ventricular decompression included 1 patient with occlusion of the junction requires removal of the left atrial drainage.
 Conclusion: Left heart decompression may contribute to increasing the success rate of VA-ECMO weaning and may help to improve the survival rate of patients with VA ECMO.