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- Left ventricle unloading during veno-arterial extracorporeal membrane oxygenation: review with updated evidence
- Yongwhan Lim, Min Chul Kim, In-Seok Jeong
- Acute Crit Care. 2024;39(4):473-487. Published online November 18, 2024
- DOI: https://doi.org/10.4266/acc.2024.00801
- 14,614 View
- 569 Download
- 6 Web of Science
- 10 Crossref
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Abstract
PDF - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to treat medically refractory cardiogenic shock and cardiac arrest, and its usage has increased exponentially over time. Although VA-ECMO has many advantages over other mechanical circulatory supports, it has the unavoidable disadvantage of increasing retrograde arterial flow in the afterload, which causes left ventricular (LV) overload and can lead to undesirable consequences during VA-ECMO treatment. Weak or no antegrade flow without sufficient opening of the aortic valve increases the LV end-diastolic pressure, and that can cause refractory pulmonary edema, blood stagnation, thrombosis, and refractory ventricular arrhythmia. This hemodynamic change is also related to an increase in myocardial energy consumption and poor recovery, making LV unloading an essential management issue during VA-ECMO treatment. The principal factors in effective LV unloading are its timing, indications, and modalities. In this article, we review why LV unloading is required, when it is indicated, and how it can be achieved.
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Citations
Citations to this article as recorded by
- Early temporary ventricular assist device intervention improves survival in fulminant myocarditis with cardiogenic shock: experience from a single centre and national cohort
Jiun-Yu Lin, Yi-Ting Tsai, Chih-Yuan Lin, Hung-Yen Ke, Jia-Lin Chen, Hsiang-Yu Yang, Wu-Chien Chien, Tsu-Hsuan Weng, Chien-Sung Tsai, Yi-Chang Lin, Po-Shun Hsu
Frontiers in Cardiovascular Medicine.2026;[Epub] CrossRef - Polymicrobial Multidrug-Resistant Infection and Fatal Bowel Ischemic Perforation After Urgent Heart Transplantation in a VA-ECMO–Bridged Recipient: A Case Report
Yangyang Jia, Yue Zhu, Hongliu Cai
Infection and Drug Resistance.2026; Volume 19: 1. CrossRef - Routine Left Ventricular Unloading During Venoarterial Extracorporeal Membrane Oxygenation—A Therapeutic Conundrum
Alice Bottussi, Jacopo D'Andria Ursoleo, Enrica Piazza, Edoardo Mongardini, Fabrizio Monaco
Journal of Cardiothoracic and Vascular Anesthesia.2025; 39(3): 860. CrossRef - Transaortic Catheter Venting for Left Ventricular Unloading in Veno-Arterial Extracorporeal Life Support: A Porcine Cardiogenic Shock Model
Sang Yoon Kim, Hyoung Woo Chang, Jae Hang Lee, Jae Hyun Jeon, Yoohwa Hwang, Hwan Hee Park, Dong Jung Kim
Medicina.2025; 61(4): 552. CrossRef - Left Heart Venting or Unloading Strategies for VA-ECMO Patients: Indications, Timing, and Techniques: A Narrative Review
YeongEun Jo, Jiae Seong, Hwa Jin Cho, Do Wan Kim, Yongwhan Lim, Yang Hyun Cho, Seunghwan Song, Min Chul Kim, Inseok Jeong
Journal of Cardiovascular Intervention.2025; 4(3): 184. CrossRef - Strategies of Revascularization and Mechanical Circulatory Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: A Systematic Review With Updated Evidence
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Journal of Cardiovascular Intervention.2025; 4(3): 212. CrossRef - Left ventricular unloading strategies in venoarterial extracorporeal membrane oxygenation patients: how much do we truly understand?
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Acute and Critical Care.2025; 40(2): 357. CrossRef - Combined mechanical circulatory support: when and why?
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Cardiologia Croatica.2025; 20(11-12): 286. CrossRef - Beyond Standard Parameters: Precision Hemodynamic Monitoring in Patients on Veno-Arterial ECMO
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Journal of Personalized Medicine.2025; 15(11): 541. CrossRef - Year 2025 in review - Cardiovascular issues in intensive care and perioperative medicine
M Pořízka, J Šoltéš, J Pudil, J Horejsek
Anesteziologie a intenzivní medicína.2025; 36(5): 328. CrossRef
- Early temporary ventricular assist device intervention improves survival in fulminant myocarditis with cardiogenic shock: experience from a single centre and national cohort
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