Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults. Issue 4 (28th November 2020)

• Record Type: Journal Article
• Authors: Kim, Ah‐Ram; Park, Hanbit; Lee, Sang‐Eun; Ahn, Jung‐Min; Park, Duk‐Woo; Lee, Seung‐Whan; Kim, Jae‐Joong; Park, Seung‐Jung; Hong, Jung Ae; Kang, Pil‐Je; Jung, Sung‐Ho; Kim, Min‐Seok
• Is Part Of: Artificial organs. Volume 45:Issue 4(2021)
• Page Start: 390
• Page End: 398
• Publication Date: 2020-11-28
• Subjects: cardiac catheterization -- cardiac transplantation -- cardiogenic shock -- extracorporeal membrane oxygenation -- interventional cardiology; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.13838
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: We evaluated the benefit of left ventricular (LV) unloading using a percutaneous transseptal left atrial (LA) drain catheter via femoral vein incorporated into the ECMO venous circuit. This single‐center retrospective observational study analyzed clinical outcomes of the LA venting group (N = 62) who underwent percutaneous transseptal LA drain placement comparing with the conventionally treated control group (N = 62) with an arterial pulse pressure below 10 mm Hg for at least 24 hours from December 2012 to August 2018. The ECMO weaning rate (61.3% vs. 38.7%, P = .012) and cardiac transplantation rate (29.0% vs. 11.3%, P = .014) were higher in the LA venting group than in the control group. Inhospital mortality was not significantly different (56.5% vs. 69.4%, P = .191). Pulmonary congestion mostly improved after LA decompression (61.3%, P = .003). A serum lactate level at 24 hours after LA venting of more than 2.2 mmol/L was associated with poor outcomes. LA venting via transseptal cannula reduced pulmonary venous congestion and achieved higher rates of successful ECMO weaning and cardiac transplantation. Placement of a transseptal venous drain cannula should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading undergoing VA‐ECMO. Abstract : Transseptal placement of a venous drain catheter was safely performed, reduced pulmonary venous congestions, triggered better clinical outcomes in ECMO weaning rate, and enhanced the possibility of cardiac transplantation. The described LA venting strategy using a transseptal cannula incorporated into the ECMO venous circuit should be considered in patients with uncontrolled pulmonary edema secondary to severe LV loading.