| Abstrakt: |
Background: LV unloading strategies during VA-ECMO support are still based on local expertise. The aim of this retrospective observational study is to investigate the current LV unloading indications and strategies. Methods: Among 2012 to 2021, patients receiving VA-ECMO associated with any LV unloading strategy were enrolled in 15 ICUs (14 located in Italy, one in the Netherlands). Data on the VA-ECMO management, unloading strategy and related applied techniques were collected. Results: 425 patients (mean age 53,8±15,9 years old, 72,6 % males, BMI 24,8,±6,92 kg/m2) were supported with VA-ECMO (6,7±5,8 days) and concomitantly received any unloading strategy (14,9%). The VA-ECMO indications were either refractory cardiogenic shock, CS (64,1 %, SCAI-class: A-B,1,6%; C,17,1%; D,44,2%; E,37,2%) or cardiac arrest, CA (35,9%). The CS indications were mainly acute coronary syndromes (35,6%), post CA (29,8%), post-cardiotomy shocks (29,6%) and acute heart failure, accounting for one fifth of CS (20,9%). At the time of LV unloading, mean arterial pressure was 60,4±21,6 mmHg, heart rate 89,9±30,3 bpm mainly in sinus rhythm (71,2%). Almost all patients were treated with inotropes/vasopressor (90,1%). LV overload was mainly defined on bed-side echocardiogram (71,2 %), arterial line pulseless (19,2%), X-ray (10,7%) and pulmonary artery catheter (2,2%). Among the echocardiographic parameters, the LV unloading interventions restored the AV opening in half of patients (52%), reverted smoke like effect in the overwhelming majority (86,3%) and effectively reduced LA and LV distension (82,8% and 85,4%, respectively). Overall, the discharge survival rate was 37,2%, mainly with a mild-moderate LV dysfunction (mean ejection fraction 48,6±13,7%). Almost one out of ten patients were bridged to Heart Transplantation (8,3%) and 5,2% bridged to LVAD. The survival of patients supported with VA-ECMO experiencing LV overload is very poor. This retrospective observational study clearly showed the crucial role of bedside echocardiogram in the LV unloading decision making. [ABSTRACT FROM AUTHOR] |
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