Venting during venoarterial extracorporeal membrane oxygenation
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Venting during venoarterial extracorporeal membrane oxygenation. / Lüsebrink, Enzo; Binzenhöfer, Leonhard; Kellnar, Antonia; Müller, Christoph; Scherer, Clemens; Schrage, Benedikt; Joskowiak, Dominik; Petzold, Tobias; Braun, Daniel; Brunner, Stefan; Peterss, Sven; Hausleiter, Jörg; Zimmer, Sebastian; Born, Frank; Westermann, Dirk; Thiele, Holger; Schäfer, Andreas; Hagl, Christian; Massberg, Steffen; Orban, Martin.
in: CLIN RES CARDIOL, Jahrgang 112, Nr. 4, 04.2023, S. 464-505.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Venting during venoarterial extracorporeal membrane oxygenation
AU - Lüsebrink, Enzo
AU - Binzenhöfer, Leonhard
AU - Kellnar, Antonia
AU - Müller, Christoph
AU - Scherer, Clemens
AU - Schrage, Benedikt
AU - Joskowiak, Dominik
AU - Petzold, Tobias
AU - Braun, Daniel
AU - Brunner, Stefan
AU - Peterss, Sven
AU - Hausleiter, Jörg
AU - Zimmer, Sebastian
AU - Born, Frank
AU - Westermann, Dirk
AU - Thiele, Holger
AU - Schäfer, Andreas
AU - Hagl, Christian
AU - Massberg, Steffen
AU - Orban, Martin
N1 - © 2022. The Author(s).
PY - 2023/4
Y1 - 2023/4
N2 - Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics-possibly with concomitant pulmonary congestion and even lung failure-and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option.
AB - Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics-possibly with concomitant pulmonary congestion and even lung failure-and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option.
U2 - 10.1007/s00392-022-02069-0
DO - 10.1007/s00392-022-02069-0
M3 - SCORING: Review article
C2 - 35986750
VL - 112
SP - 464
EP - 505
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 4
ER -