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MANAGE LEFT VENTRICULAR OVERLOAD IN VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION WITH INTRA-AORTIC BALLOON PUMP AND TRANSAORTIC CATHETER VENTING
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Abstract
Background: Left ventricular overload is common in cardiogenic shock patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Less invasive intervention techniques including transaortic catheter venting (TACV) and intra-aortic balloon pump (IABP) have involved in management of this complication. We aimed to describe changes in left ventricular function, outcomes and intervention-related complications of those techniques. Methods: Observational study on patients at Critical Care Department of Cho Ray hospital who was supported with VA-ECMO and had left ventricular overload from January 2020 to June 2021. Data about patient’s backgroud at admission, left ventricular overload, parameters of left ventricular function before and after intervention as well as ECMO and survival outcome were collected. Results: 31 patients were included. 19 (63%) patients were vented with TACV and/or IABP, mostly on the first day of left ventricular overload. 7Fr was most used TACV size with median flow of 100 mL/min. Recovery rate in vented group was 57,9%. Venting with TAVC and/or IABP increase pulse pressure (10mmHg to 30mmHg, p=0,006), ejection fraction (15% to 27%, p=0,010) and aortic valve velocity time integral (AV VTI) (4,2cm to 8,9cm, p<0,001). Intervention-related complication rates was low, including insertion-site bleeding, limb ischemia and TACV occlusion. Conclusion: Venting with TACV and IABP can improve left ventricular functions in VA ECMO patients with left ventricular overload.
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Keywords
extracorporeal membrane oxygenation, transaortic catheter venting, intra-aortic balloon pump, left ventricular overload
References
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