Efficacy of left heart decompression during extracorporeal membrane oxygenation: a case-control study

Background: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is used in various cardiogenic shocks. In severe myocardial dysfunction, left heart (LH) distension may occur and aggravate pulmonary edema. Despite the recent case reports on various venting catheter insertion methods for LH decompression, the necessity and efficacy of LH venting procedure are still controversial. Therefore, we focused on evaluating efficacy of LH venting catheter insertion for LH decompression.

Methods: In total, 373 patients received VA ECMO at our institution from May 2012 to January 2016. Of these, 25 patients underwent LH venting catheter insertion. Indication for the procedure included pulmonary congestion observed on chest radiogram, with arterial pulse pressure ≤10 mmHg. The control group comprised of 45 patients with peripheral VA ECMO having arterial pulse pressure ≤ for ≥24 hours during the same study period who did not undergo LH venting procedure. Finally, 70 patients were compared and analyzed.

Results: Mean age of the patients was 52.6±17.1 years. The ECMO running time in each group was 7.2±7.1 days in the vent (-) group and 9.2±8.5 days in the vent (+) group. Successful weaning rate was higher in the LH vent (+) group (P=0.08). Moreover, LH venting catheter insertion was identified as a predictor of weaning success with marginal significance (OR =2.47; 95% CI: 0.90-6.72; P=0.07).

Conclusions: LH decompression by venting catheter insertion in patients on VA ECMO may be more effective and helpful for successful ECMO weaning than conventional medical management without survival benefit.