Dugar Siddharth Pawan, Sato Ryota, Charlton Matthew, Hasegawa Daisuke, Antonini Marta Velia, Nasa Prashant, Yusuff Hakeem, Schultz Marcus J, Harnegie Mary Pat, Ramanathan Kollengode, Shekar Kiran, Schmidt Matthieu, Zochios Vasileios, Duggal Abhijit
From the Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.
ASAIO J. 2025 Jun 1;71(6):482-491. doi: 10.1097/MAT.0000000000002369. Epub 2025 Jan 9.
Right ventricular injury (RVI) in respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A scoping review is necessary to map the current literature and guide future research regarding the definition and management of RVI in patients receiving VV ECMO. We searched for relevant publications on RVI in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Of 1,868 citations screened, 30 studies reported on RVI (inclusive of right ventricular dilation, right ventricular dysfunction, and right ventricular failure) during VV ECMO. Twenty-three studies reported on the definition of RVI including echocardiographic indices of RV function and dimensions, whereas 13 studies reported on the management of RVI, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation (Ultra-LPV), and optimization of positive end-expiratory pressure (PEEP). The definitions of RVI in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RVI during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RVI are also lacking. To fill the existing knowledge gaps, a consensus on the definition of RVI and research investigating RV-targeted therapies during VV ECMO is urgently warranted.
接受静脉-静脉体外膜肺氧合（VV ECMO）治疗的呼吸衰竭患者发生右心室损伤（RVI）与显著的死亡率相关。有必要进行一项范围综述，以梳理当前文献，并指导未来关于接受VV ECMO治疗的患者RVI定义和管理的研究。我们在Medline、EMBASE和科学网中搜索了关于接受VV ECMO治疗患者RVI的相关出版物。在筛选的1868篇文献中，30项研究报告了VV ECMO期间的RVI（包括右心室扩张、右心室功能障碍和右心室衰竭）。23项研究报告了RVI的定义，包括右心室功能和大小的超声心动图指标，而13项研究报告了RVI的管理，包括静脉-肺（VP）ECMO、静脉-动脉（VA）ECMO、正性肌力药物、肺血管扩张剂、超肺保护性通气（Ultra-LPV）以及呼气末正压（PEEP）的优化。文献中用于接受VV ECMO治疗患者的RVI定义各不相同。尽管在VV ECMO支持期间RVI的发生率很高，且与死亡率密切相关，但针对RVI治疗策略的研究也很缺乏。为填补现有知识空白，迫切需要就RVI的定义达成共识，并开展关于VV ECMO期间针对右心室治疗的研究。
