Left ventricular venting during veno-arterial ECMO

As discussed in previous chapters, Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) is the end-of-the-line therapy for cardiogenic shock [1]. VA-ECMO is able to take over the function of the heart and lungs and support perfusion of oxygenated blood to the critically ill patient [2]. This is a high-risk treatment with high mortality but is usually offered in patients with little to no other therapeutic options. In concept VA-ECMO, is similar to cardiopulmonary bypass used during cardiac surgery but has several physiologic differences that combined can be detrimental to the myocardial recovery of the patient [3]. To avoid the potential detrimental effects of VAECMO, we advocate left ventricular unloading during select patients undergoing ECMO support [4]. In this chapter we will discuss the pathophysiology underscoring the need for venting of the left ventricle during VA-ECMO, how this can be achieved, when should it be done, and how the effectiveness these options in recovering the failing left ventricle.