Conversion of extracorporeal membrane oxygenation to non-pulsatile left ventricular assist device. Is it out-of-date for non-pulsatile LVAD?
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) provides an immediate support for acute deterioration of hemodynamic and pulmonary status, but what is the best decision for these critical patients? Biventricular assist device (BVAD) or left ventricular assist device (LVAD)? We proposed a protocol of step-by-step conversion from ECMO to LVAD after assurance of the reversibility of right ventricle and pulmonary function.


METHODS
After femoral venoarterial ECMO was inserted for the critical patients, the left atrial drainage was added to the ECMO firstly and the femoral arterial inflow was shifted to the ascending aorta for preventing possible peripheral vascular complications. Temporary clamp of right heart drainage was tried to test right heart function 24 to 48 hours later. The sweep gas flow of oxygenator could be reduced gradually to test the pulmonary function. Therefore, the right heart drain and the oxygenator could be withdrawn to become a non-pulsatile LVAD or shift to pneumatic LVAD directly. There were four clinical experiences with successful conversion without temporary right ventricular assist device.


RESULTS
All of them were able to convert their ECMO to LVAD smoothly in 8.0+/-2.5 days. Three of them were shifted to non-pulsatile LVAD, and one was converted to HeartMate. All but one could be weaned from the ventilator. No BVAD was needed in these patients. Due to the shortage of donor hearts, only one had the chance to undergo heart transplantation.


CONCLUSIONS
The protocol did provide a good guideline for decision-making for those under ECMO support necessitating bridge to transplantation.
Chen
Y S
YS
Department of Surgery, National Taiwan University Hospital, No. 7 Chung-Shan S. Rd., Taipei 100, Taiwan.
Ko
W J
WJ
Chou
T F
TF
Chou
N K
NK
Hsu
R B
RB
Wang
S S
SS
Lin
F Y
FY
Chu
S H
SH
D002316:Cardiotonic Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D015259:Dopamine Agents / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D012131:Respiratory Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000628:therapy; D013997:Time Factors; D015300:Ventilator Weaning / Q000379:methods*
D002316:Cardiotonic Agents; D015259:Dopamine Agents; D004280:Dobutamine; D004298:Dopamine