Lim Yongwhan, Kim Min Chul, Jeong In-Seok
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
Acute Crit Care. 2024 Nov;39(4):473-487. doi: 10.4266/acc.2024.00801. Epub 2024 Nov 18.
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.
静脉-动脉体外膜肺氧合（VA-ECMO）被广泛用于治疗药物难治性心源性休克和心脏骤停，并且其使用量随时间呈指数增长。尽管VA-ECMO相较于其他机械循环支持有许多优势，但它有一个不可避免的缺点，即增加后负荷中的逆行动脉血流，这会导致左心室（LV）负荷过重，并可能在VA-ECMO治疗期间导致不良后果。在主动脉瓣没有充分开放的情况下，微弱或无顺行血流会增加左心室舒张末期压力，进而可能导致难治性肺水肿、血液淤滞、血栓形成和难治性室性心律失常。这种血流动力学变化还与心肌能量消耗增加和恢复不良有关，使得左心室减负成为VA-ECMO治疗期间的一个关键管理问题。有效左心室减负的主要因素包括其时机、适应症和方式。在本文中，我们综述了为什么需要左心室减负、何时适用以及如何实现左心室减负。
