title: Trans-diaphragmatic left ventricular venting during peripheral venous-arterial extracorporeal membrane oxygenation.
abstract: Extracorporeal membrane oxygenation (ECMO) has proven to be an invaluable method of cardiopulmonary support in cases of severe cardiogenic shock. In an emergency, femoral artery and vein cannulation is the easiest and quickest access to initiate support. Often, with peripheral venous-arterial ECMO (VA ECMO), an inadequate reduction in left ventricular end-diastolic pressure (LVEDP) is present secondary to increased afterload from retrograde flow, inadequate RV drainage or persistent bronchial circulation. Elevated LVEDP has been known to be associated with poor myocardial recovery, LV thrombus formation and significant pulmonary edema. A cannulation strategy to achieve partial ventricular unloading is of paramount importance when considering ECMO support following cardiogenic shock to increase the potential for myocardial recovery. We present a novel case of emergent peripheral VA ECMO cannulation with a trans-diaphragmatic left ventricular (LV) vent in a 61-year-old, 79 kg male with end-stage liver disease and hepatitis B cirrhosis who suffered cardiac arrest during orthotopic liver transplantation.
authors.affiliation: Division of Cardiothoracic Surgery and Department of Clinical Perfusion, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Eudailey
authors.affiliation: Transplant Surgery, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA.
authors.forename: Soo Youn
authors.initials: SY
authors.lastname: Yi
authors.affiliation: Division of Cardiothoracic Surgery and Department of Clinical Perfusion, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA.
authors.forename: Linda Bodnar
authors.initials: LB
authors.lastname: Mongero
authors.affiliation: Anesthesiology, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA.
authors.forename: Gebhard
authors.initials: G
authors.lastname: Wagener
authors.affiliation: Transplant Surgery, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA.
authors.forename: James V
authors.initials: JV
authors.lastname: Guarrera
authors.affiliation: Division of Cardiothoracic Surgery and Department of Clinical Perfusion, New York Presbyterian Hospital - Columbia College of Physicians and Surgeons, New York Presbyterian Hospital-Columbia University Medical Center, New York, NY, USA ig2006@cumc.columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D058625:End Stage Liver Disease / Q000150:complications / Q000601:surgery*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D020257:Ventricular Remodeling
keywords: LV vent; VA ECMO; cannulation strategies; extracorporeal membrane oxygenation; inadequate RV drainage