Incidence and Implications of Left Ventricular Distention During Venoarterial Extracorporeal Membrane Oxygenation Support

• Published in: ASAIO journal (1992) Vol. 63; no. 3; pp. 257 - 265
• Main Authors: Truby, Lauren K, Takeda, Koji, Mauro, Christine, Yuzefpolskaya, Melana, Garan, Arthur R, Kirtane, Ajay J, Topkara, Veli, Abrams, Darryl, Brodie, Daniel, Colombo, Paolo C, Naka, Yoshifumi, Takayama, Hiroo
• Format: Journal Article
• Language: English
• Published: United States Copyright by the American Society for Artificial Internal Organs 01-05-2017
• ISSN: 1058-2916; 1538-943X
• DOI: 10.1097/MAT.0000000000000553

Left ventricular distention (LVD) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is increasingly recognized but seldom reported in the literature. The present study defined LVD as not present (LVD-); subclinical (LVD+, evidence of pulmonary edema on chest radiograph AND pulmonary artery diastolic blood pressure greater than 25 mmHg within the first 2 hours of ICU admission); or clinical (LVD++, need for decompression of the left ventricle immediately following VA-ECMO initiation). Among 226 VA-ECMO device runs, 121 had sufficient data to define LVD retrospectively. Nine patients (7%) developed LVD++ requiring immediate decompression, and 27 patients (22%) met the definition of LVD+. Survival to discharge was similar among groups (LVD++44%, LVD+41%, LVD-44%). However, myocardial recovery appeared inversely related to degree of LVD (LVD++11%, LVD+26%, LVD-40%). When death or transition to device was considered as a composite outcome, event-free survival was diminished in LVD++ and LVD+ patients as compared to LVD-. Multivariable analysis identified cannulation of VA-ECMO during CPR (ECPR) as a risk factor for decompression (OR3.64, CI1.21 – 10.98, p=0.022). Using a novel definition of LVD, the severity LVD was inversely related to the likelihood of myocardial recovery. Survival did not differ between groups. ECPR was associated with need for mechanical intervention.