Unloading the Left Ventricle in Venoarterial ECMO: In Whom, When, and How?

被引：95

作者：

Ezad, Saad M. ^{[1
,2
]}

Ryan, Matthew ^{[1
,2
]}

Donker, Dirk W. ^{[3
,4
]}

Pappalardo, Federico ^{[5
]}

Barrett, Nicholas ^{[6
]}

Camporota, Luigi ^{[6
]}

Price, Susanna ^{[7
,8
,9
]}

Kapur, Navin K. ^{[10
]}

Perera, Divaka ^{[1
,2
,11
]}

机构：

[1] Kings Coll London, British Heart Fdn Ctr Res Excellence, Sch Cardiovasc & Metab Med & Sci, London, England

[2] Natl Inst Hlth, Kings Coll London, Care Res Biomed Res Ctr, Sch Cardiovasc & Metab Med & Sci, London, England

[3] Univ Utrecht, Univ Med Ctr Utrecht, Utrecht, South Africa

[4] Univ Twente, Cardiovasc & Resp Physiol, Enschede, Netherlands

[5] Cardiothorac & Vasc Anesthesia & Intens Care, Azienda Osped Santi Antonio & Biagio & Cesare Arri, Alessandria, Italy

[6] Guys & St Thomas Nat Hlth Serv Fdn Trust, Dept Crit Care Med, London, England

[7] Royal Brompton & Harefield Hosp, Dept Crit Care, London, England

[8] Royal Brompton & Harefield Hosp, Dept Cardiol, London, England

[9] Imperial Coll, Natl Heart & Lung Inst, London, England

[10] Tufts Med Ctr, Cardiovasc Ctr, Boston, MA USA

[11] St Thomas Hosp, Rayne Inst, Cardiovasc Div, Westminster Bridge Rd, London SE1 7EH, England

来源：

CIRCULATION | 2023年 / 147卷 / 16期

基金：

美国国家卫生研究院;

关键词：

extracorporeal membrane oxygenation; heart-assist devices; heart failure; hemodynamics; myocardial infarction; shock; cardiogenic; EXTRACORPOREAL MEMBRANE-OXYGENATION; INTRAAORTIC BALLOON COUNTERPULSATION; CARDIOGENIC-SHOCK PATIENTS; LEFT-HEART DECOMPRESSION; LIFE-SUPPORT; CIRCULATORY SUPPORT; ATRIAL SEPTOSTOMY; IMPELLA; FLOW; DISTENSION;

D O I：

10.1161/CIRCULATIONAHA.122.062371

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.

引用

页码：1237 / 1250

页数：14

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