Ventricular unloading with a miniature axial flow pump in combination with extracorporeal membrane oxygenation.
OBJECTIVE
ECMO for acute cardiorespiratory failure is an established therapeutic option. Persistent insufficient unloading of the left ventricle (LV) can compromise recovery of ventricular function. We decided to insert a miniature rotary blood pump (Impella) for decompression of the LV. In contrast to previous experience with this new device, where it was generally used for postcardiotomy heart failure or cardiogenic shock and inserted in the operating room or the catheter laboratory, this is the first report describing the potential of this technology in the intensive care unit, in a patient on ECMO and the value of echocardiography guidance.


METHODS
A 13-year-old boy with a history of congenital heart disease was admitted to the ICU with acute cardio-respiratory failure.


METHODS
On day 2 venoarterial ECMO was instituted because of worsening cardiorespiratory insufficiency refractory to conventional treatment. On day 5 a percutaneous rotary blood pump was inserted to decompress the LV.


CONCLUSIONS
A percutaneous miniature rotary blood pump can be an alternative to decompress a failing LV in the setting of VA-ECMO. Echocardiography can avoid the use of fluoroscopy and the transport to a catheter laboratory to insert the rotary pump.
Vlasselaers
Dirk
D
Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. dirk.vlasselaers@uz.kuleuven.ac.be.
Desmet
Matthias
M
Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Desmet
Lars
L
Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Meyns
Bart
B
Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Dens
Joseph
J
Department of Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
D000293:Adolescent; D004452:Echocardiography; D015199:Extracorporeal Membrane Oxygenation; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008904:Miniaturization; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*