AI Article Synopsis

  • Veno-arterial ECMO helps improve organ perfusion in cases of cardiogenic shock, but can also increase afterload, potentially hindering heart recovery and necessitating LV unloading strategies.
  • A global survey of 192 healthcare professionals revealed that over half routinely use mechanical LV unloading, while concerns about complications deter some from doing so.
  • The most common reasons for unplanned unloading included low arterial pulsatility and pulmonary issues, with intra-aortic balloon pumps being the preferred unloading device, highlighting the need for more research on unloading strategies.

Article Abstract

Introduction: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid cardiac recovery and prevent complications of increased afterload. However, there is no consensus on when and which unloading strategy should be used.

Methods: An online survey was distributed worldwide via the EuroELSO newsletter mailing list to describe contemporary international practice and evaluate heterogeneity in strategies for LV unloading.

Results: Of 192 respondents from 43 countries, 53% routinely use mechanical LV unloading, to promote ventricular recovery and/or to prevent complications. Of those that do not routinely unload, 65% cited risk of complications as the reason. The most common indications for unplanned unloading were reduced arterial line pulsatility (68%), pulmonary edema (64%) and LV dilatation (50%). An intra-aortic balloon pump was the most frequently used device for unloading followed by percutaneous left ventricular assist devices. Echocardiography was the most frequently used method to monitor the response to unloading.

Conclusions: Significant variation exists with respect to international practice of ventricular unloading. Further research is required that compares the efficacy of different unloading strategies and a randomized comparison of routine mechanical unloading versus unplanned unloading.

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Source
http://dx.doi.org/10.1177/02676591241229647DOI Listing

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