Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiorespiratory support for patients in cardiogenic shock despite high-dose inotropic therapy and use of an intra-aortic balloon pump (IABP) [Muehrcke 1996]. Postcardiotomy cardiogenic shock has an incidence of 2%-6% after routine adult cardiac surgery [Hernandez 2007]. There are 0.5%-1.5% of patients who are refractory to medical and device therapy, and cardiogenic shock can lead to multiorgan dysfunction and mortality [Rastan 2010]. Prolonged cardiorespiratory support, which can be achieved with ECMO, may provide time for myocardial recovery and prevent multiorgan dysfunction and reduce mortality [Smedira 2001]. However, this device is associated with serious complications [Khorsandi 2017]. The reported survival rate on ECMO is 36% [Biancari 2018]. The aim of this study is to follow up on factors that can influence therapy outcome for patients who receive VA-ECMO after cardiac surgery.

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Prolonged cardiorespiratory support can be achieved with ECMO that may provide time for myocardial recovery, prevent multiorgan dysfunction and reduce mortality. Left ventricle (LV) distension can worsen already distended and hypocontractile heart. Early recognition and aggressive management of LV distension are essential for the treatment of patients with low cardiac output. The case report presented intends to show advantages of left ventricular venting on ECMO after post-cardiotomy shock. With direct flow measurements on bypass-grafts before and after the vent implantation, it was possible to clearly demonstrate the importance of venting for myocardial perfusion.

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