title: Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern.
abstract: Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for severe respiratory and cardiac failure. Right ventricular (RV) failure with cardiogenic shock is a critical condition with generally poor prognosis unless aggressive therapeutical measures are undertaken. Authors report on their initial experience with ECMO support in severe RV failure with cardiogenic shock caused by an obstructive hemodynamic pattern. Four patients with cardiogenic shock due to severe RV failure related to pulmonary arterial hypertension (2 patients), congenital heart disease with Eisenmenger physiology (1 subject) and massive pulmonary embolism (1 patient) were supported with emergency veno-arterial ECMO. ECMO circuit was instituted using peripheral cannulation in all subjects. Immediate hemodynamic and ventilatory improvement was observed in all patients. The mean support duration was 11 days (range 5-16 days), 2 (50%) patients were successfully weaned off ECMO and survived to hospital discharge. The other 2 patients were considered by mutual consensus to have irreversible organ damage, the ECMO support was withdrawn and the patients died. Bleeding complications were the main complications observed. As per initial experience, veno-arterial ECMO allows bypassing of the pulmonary bed, therefore, relieves the RV pressure overload and does not cause further elevation of the pulmonary pressures in contrary to RV assist devices. This aggressive management approach requires further clinical evaluation in order to establish its definite role in critical RV failure.
authors.affiliation: 2nd Department of Internal Medicine, Cardiology and Angiology, General Teaching Hospital, 1st Medical School, Charles University, Prague, Czech Republic. jbelo@vfn.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Belohlavek
authors.forename: Vilem
authors.initials: V
authors.lastname: Rohn
authors.forename: Pavel
authors.initials: P
authors.lastname: Jansa
authors.forename: Jan
authors.initials: J
authors.lastname: Tosovsky
authors.forename: Jan
authors.initials: J
authors.lastname: Kunstyr
authors.forename: Michal
authors.initials: M
authors.lastname: Semrad
authors.forename: Jan
authors.initials: J
authors.lastname: Horak
authors.forename: Michal
authors.initials: M
authors.lastname: Lips
authors.forename: Frantisek
authors.initials: F
authors.lastname: Mlejnsky
authors.forename: Martin
authors.initials: M
authors.lastname: Balik
authors.forename: Andrew
authors.initials: A
authors.lastname: Klein
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Lindner
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000503:physiopathology / Q000628:therapy; D004541:Eisenmenger Complex / Q000503:physiopathology / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome