Ricarte Bratti Juan Pablo, Cavayas Yiorgos Alexandros, Noly Pierre Emmanuel, Serri Karim, Lamarche Yoan
Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada.
Hôpital Sacré-Coeur de Montréal, 5400. Gouin Blvd. West, Montreal, QC H4J 1C5, Canada.
Membranes (Basel). 2021 Mar 16;11(3):209. doi: 10.3390/membranes11030209.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to sustain circulatory and respiratory support in patients with severe cardiogenic shock or refractory cardiac arrest. Although VA-ECMO allows adequate perfusion of end-organs, it may have detrimental effects on myocardial recovery. Hemodynamic consequences on the left ventricle, such as the increase of afterload, end-diastolic pressure and volume, can lead to left ventricular (LV) distention, increase of myocardial oxygen consumption and delayed LV function recovery. LV distention occurs in almost 50% of patients supported with VA-ECMO and is associated with an increase in morbidity and mortality. Thus, recognizing, preventing and treating LV distention is key in the management of these patients. In this review, we aim to discuss the pathophysiology of LV distention and to describe the strategies to unload the LV in patients supported with VA-ECMO.
静脉-动脉体外膜肺氧合（VA-ECMO）用于为严重心源性休克或难治性心脏骤停患者提供循环和呼吸支持。尽管VA-ECMO能使终末器官得到充分灌注，但它可能对心肌恢复产生不利影响。对左心室的血流动力学影响，如后负荷、舒张末期压力和容积增加，可导致左心室（LV）扩张、心肌氧消耗增加及左心室功能恢复延迟。几乎50%接受VA-ECMO支持的患者会发生左心室扩张，且与发病率和死亡率增加相关。因此，识别、预防和治疗左心室扩张是这些患者管理中的关键。在本综述中，我们旨在探讨左心室扩张的病理生理学，并描述在接受VA-ECMO支持的患者中减轻左心室负荷的策略。
