Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 34; no. 1; pp. 208 - 218
• Main Authors: Desai, Suneel Ramesh, Hwang, Nian Chih
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Cardiopulmonary Resuscitation; Decompression; extracorporeal cardiopulmonary resuscitation; Extracorporeal Membrane Oxygenation; Heart Ventricles - diagnostic imaging; Heart Ventricles - surgery; Heart-Assist Devices; Humans; Impella; intracardiac thrombus; left ventricular distension; Tandem Heart; upper body hypoxemia; Impella; left ventricular distension; intracardiac thrombus; extracorporeal cardiopulmonary resuscitation; Tandem Heart; upper body hypoxemia
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2019.08.024

Extracorporeal cardiopulmonary resuscitation involves the application of venoarterial extracorporeal membrane oxygenation for patients in cardiac arrest who have received good quality conventional cardiopulmonary resuscitation, and who are deemed to have a reversible cause and no contraindications. Systemic perfusion is maintained by the extracorporeal life support, allowing time for the underlying cause to be treated and the heart to recover. Specific considerations to promote cardiac recovery are discussed, including the maintenance of sinus rhythm, promotion of cardiac ejection, management of pulmonary hypertension, management of intravascular volume, and prevention of ventricular distention. Advanced strategies for ventricular decompression including atrial septostomy and percutaneous ventricular assist devices are discussed.