Left ventricular hemodynamics with veno‐arterial extracorporeal membrane oxygenation

Abstract

AbstractBackgroundThere is considerable debate about the hemodynamic effects of veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO).AimsTo evaluate the changes in left ventricular (LV) function, volumes, and work in patients treated with VA‐ECMO using invasive LV catheterization and three‐dimensional echocardiographic volumes.MethodsPatients on VA‐ECMO underwent invasive hemodynamic evaluation due to concerns regarding candidacy for decannulation. Hemodynamic parameters were reported as means±standard deviations or medians (interquartile ranges) after evaluating for normality. Paired comparisons were done to evaluate hemodynamics at the baseline (highest) and lowest tolerated levels of VA‐ECMO support.ResultsTwenty patients aged 52.3 ± 15.8 years were included. All patients received VA‐ECMO for refractory cardiogenic shock (5/20 SCAI stage D, 15/20 SCAI stage E). At 3.0 (2.0, 4.0) days after VA‐ECMO cannulation, the baseline LV ejection fraction was 20% (15%, 27%). The baseline and lowest VA‐ECMO flows were 4.0 ± 0.6 and 1.5 ± 0.6 L/min, respectively. Compared to the lowest flow, full VA‐ECMO support reduced LV end‐diastolic volume [109 ± 81 versus 134 ± 93 mL, p = 0.001], LV end‐diastolic pressure (14 ± 9 vs. 19 ± 9 mmHg, p < 0.001), LV stroke work (1858 ± 1413 vs. 2550 ± 1486 mL*mmHg, p = 0.002), and LV pressure‐volume area (PVA) (4507 ± 1910 vs. 5193 ± 2388, p = 0.03) respectively. Mean arterial pressure was stable at the highest and lowest flows (80 ± 16 vs. 75 ± 14, respectively; p = 0.08) but arterial elastance was higher at the highest VA‐ECMO flow (4.9 ± 2.2 vs lowest flow 2.7 ± 1.6; p < 0.001).ConclusionsHigh flow VA‐ECMO support significantly reduced LV end‐diastolic pressure, end‐diastolic volume, stroke work, and PVA compared to minimal support. The Ea was higher and MAP was stable or minimally elevated on high flow.