Left Ventricular Unloading in Extracorporeal Membrane Oxygenation: A Clinical Perspective Derived from Basic Cardiovascular Physiology.

Autor: Protti I; Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands.; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy., van Steenwijk MPJ; Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands., Meani P; Maastricht University Medical Center+, Cardiothoracic Surgery, Heart and Vascular Center, Maastricht, the Netherlands., Fresiello L; Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Hallenweg 5, 7522, NH, Enschede, The Netherlands., Meuwese CL; Departments of Cardiology and Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands., Donker DW; Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Hallenweg 5, 7522, NH, Enschede, The Netherlands. d.w.donker@utwente.nl.; Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands. d.w.donker@utwente.nl.
Jazyk: angličtina
Zdroj: Current cardiology reports [Curr Cardiol Rep] 2024 Jul; Vol. 26 (7), pp. 661-667. Date of Electronic Publication: 2024 May 07.
DOI: 10.1007/s11886-024-02067-w
Abstrakt: Purpose of Review: To present an abridged overview of the literature and pathophysiological background of adjunct interventional left ventricular unloading strategies during veno-arterial extracorporeal membrane oxygenation (V-A ECMO). From a clinical perspective, the mechanistic complexity of such combined mechanical circulatory support often requires in-depth physiological reasoning at the bedside, which remains a cornerstone of daily practice for optimal patient-specific V-A ECMO care.
Recent Findings: Recent conventional clinical trials have not convincingly shown the superiority of V-A ECMO in acute myocardial infarction complicated by cardiogenic shock as compared with medical therapy alone. Though, it has repeatedly been reported that the addition of interventional left ventricular unloading to V-A ECMO may improve clinical outcome. Novel approaches such as registry-based adaptive platform trials and computational physiological modeling are now introduced to inform clinicians by aiming to better account for patient-specific variation and complexity inherent to V-A ECMO and have raised a widespread interest. To provide modern high-quality V-A ECMO care, it remains essential to understand the patient's pathophysiology and the intricate interaction of an individual patient with extracorporeal circulatory support devices. Innovative clinical trial design and computational modeling approaches carry great potential towards advanced clinical decision support in ECMO and related critical care.
(© 2024. The Author(s).)
Databáze: MEDLINE
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