Pathophysiology of cardiac extracorporeal membrane oxygenation.
The treatment of cardiogenic shock using inotropic agents and vascular volume expansion places an added burden on the heart. The resultant increase in cardiac work may cause myocardial ischemia and lead to cardiac arrest. Extracorporeal membrane oxygenation (ECMO) may be used to treat cardiogenic shock. It supports systemic circulation, assures diastolic perfusion of the myocardium, and reduces cardiac workload. The rise in blood pressure associated with restoring systemic circulation afterloads the heart and can cause left atrial hypertension and pulmonary edema. ECMO does not automatically reduce cardiac work, especially in the presence of residual shunts. Left atrial drainage or decompression may be essential in certain patients both to avert pulmonary edema and to reduce cardiac work.
Fuhrman
B P
BP
State University of New York at Buffalo and Children's Hospital of Buffalo, 14222, USA.
Hernan
L J
LJ
Rotta
A T
AT
Heard
C M
CM
Rosenkranz
E R
ER
D016279:Atrial Function, Left / Q000502:physiology; D001775:Blood Circulation / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003326:Coronary Circulation / Q000502:physiology; D003971:Diastole; D004322:Drainage; D015199:Extracorporeal Membrane Oxygenation; D006321:Heart / Q000503:physiopathology*; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D017202:Myocardial Ischemia / Q000209:etiology; D010952:Plasma Substitutes / Q000627:therapeutic use; D011654:Pulmonary Edema / Q000209:etiology; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology
D002316:Cardiotonic Agents; D010952:Plasma Substitutes