Saeed Omar, Nunez Jose I, Jorde Ulrich P
Department of Medicine, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY, 10023, USA.
Lung. 2023 Apr;201(2):119-134. doi: 10.1007/s00408-023-00616-8. Epub 2023 Apr 12.
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in adults for refractory cardiogenic shock has risen exponentially during the prior decade. Although VA-ECMO provides cardiopulmonary support, it can alter left ventricular (LV) loading conditions leading to LV distension, which makes the lungs susceptible to congestion and promotes intracardiac thrombosis. These conditions can be alleviated by pharmacologic and mechanical unloading, but gaps in knowledge remain on optimal timing and methods of this approach. This review provides an overview of the epidemiology of VA-ECMO, describes pathophysiology and methods for monitoring and reducing LV loading and summarizes contemporary studies examining the association between LV unloading and adverse events. We offer a simple protocol for implementing LV unloading during VA-ECMO to provide pulmonary protection and improve outcomes.
在过去十年中，成人使用静脉-动脉体外膜肺氧合（VA-ECMO）治疗难治性心源性休克的情况呈指数级增长。尽管VA-ECMO提供心肺支持，但它会改变左心室（LV）的负荷条件，导致左心室扩张，这会使肺部易发生充血并促进心内血栓形成。这些情况可通过药物和机械减负来缓解，但在这种方法的最佳时机和方法方面仍存在知识空白。本综述概述了VA-ECMO的流行病学，描述了病理生理学以及监测和减轻左心室负荷的方法，并总结了当代研究中关于左心室减负与不良事件之间关联的研究。我们提供了一个在VA-ECMO期间实施左心室减负的简单方案，以提供肺保护并改善预后。
