Feb 10, 2016 · Before ECMO, the median mean arterial pressure (MAP) was 40 mmHg (interquartile range (IQR) 33–46), the median arterial lactate level was 7.8 mmol/L (IQR 6.3–16.3), and the median left ventricular ejection fraction was 42.5 % (IQR 23.5–50.0). Despite adequate fluid and vasopressor therapy, refractory shock proceeded.
Nov 14, 2018 · When detect refractory pulmonary congestion on chest radiograph or inadequate AV opening on serial echocardiography, we will perform LA venting for improving LV distention in patients with refractory cardiogenic shock who received VA-ECMO support.
Jan 21, 2014 · Patients who have received VA-ECMO with predominately right ventricular failure can be adversely affected by high PEEP [54, 55]. Conversely, patients with predominately left ventricular failure supported with VA-ECMO may develop pulmonary edema despite adequate systemic support and often benefit from the application of high PEEP .
Jul 14, 2015 · As time on a VA-ECMO circuit increases, left ventricular distention is lv vent va ecmo more likely to occur. VA-ECMO creates a large amount of afterload for the left ventricle (LV) to work against. This can commonly lead to LV distention and, subsequently, pulmonary edema. Various strategies have been used to assist in LV decompression for patients on ECMO.
It provides systemic perfusion, but left ventricular (LV) unloading is suboptimal. Using a closed-loop, real-time computer model of the human cardiovascular system, cardiogenic shock supported by peripheral VA ECMO was simulated, and effects of various adjunct LV unloading interventions were quantified.
The largest study so far describing the use of lv vent va ecmo the IMPELLA ® pump concomitantly to VA ECMO like Truby et al. was published last year by Pappalardo et al. including 157 VA ECMO patients . The indication to vent the LV was seen in 34 patients (21%) without describing a clear indication to vent the LV.
Nov 08, 2019 · Despite adequate venous drainage, some blood will always find its way back to the LV via pathways like aortic insufficiency and bronchial venous drainage. Devices like the Impella are used in conjunction with VA-ECMO (“Ecpella” configuration) to actively “vent” the LV.
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