Proposal for a trial of early left ventricular venting during venoarterial extracorporeal membrane oxygenation for cardiogenic shock

Michael Ibrahim, Michael A. Acker, Wilson Szeto, Jacob Gutsche, Matthew Williams, Pavan Atluri, Matthew Woods, Thomas Richards, Timothy J. Gardner, Jeremy McGarvey, Mark Epler, Joyce Wald, Eduardo Rame, Edo Birati, Christian Bermudez

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objective: Patients with profound cardiogenic shock may require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for circulatory support most commonly via the femoral vessels. The rate of cardiac recovery in this population remains low, possibly because peripheral VA-ECMO increases ventricular afterload. Whether direct ventricular unloading in peripheral VA-ECMO enhances cardiac recovery is unknown, but is being more frequently utilized. A randomized trial is warranted to evaluate the clinical effectiveness of percutaneous left ventricle venting to enhance cardiac recovery in the setting of VA-ECMO. Methods: We describe the rationale, design, and initial testing of a randomized controlled trial of VA-ECMO with and without percutaneous left ventricle venting using a percutaneous micro-axial ventricular assist device. Results: This is an ongoing prospective randomized controlled trial in adult patients with primary cardiac failure presenting in cardiogenic shock requiring peripheral VA-ECMO, designed to test the safety and effectiveness of percutaneous left ventricle venting in improving the rate of cardiac recovery. Conclusions: The results of this nonindustry-sponsored trial will provide critical information on whether left ventricle unloading in peripheral VA-ECMO is safe and effective.

Original languageEnglish
Pages (from-to)393-400
Number of pages8
JournalJTCVS Open
Volume8
DOIs
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 The Author(s)

Keywords

  • cardiac recovery
  • cardiogenic shock

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