Echocardiographic Assessment of Biventricular Function in 249 Patients During the Peri-Extracorporeal Membrane Oxygenation Period: Procedural and Ethical Questions

Abstract

USE OF EXTRACORPOREAL membrane oxygenation (ECMO) has increased dramatically in recent years. The use of ECMO catapulted around 2009 because of the following 3 major events: the global pandemic of the H1N1 influenza, the publication of the CESAR trial, and ongoing improvements in ECMO circuitry with polymethylpentene oxygenators and cannulae specifically designed for ECMO. 1 As discussed by Ortoleva et al. in this issue of the Journal of Cardiothoracic and Vascular Anesthesia, the Extracorporeal Life Support Organization reported more than 10,000 ECMO cases in 379 centers in 2017. 2,3 In fact, ECMO has become inculcated into the advanced cardiorespiratory failure resuscitation algorithm in many hospitals. This dramatic increase in ECMO use has placed emphasis on emerging evidence correlating ventricular functional recovery and survival in ECMO patients. The analysis performed by Ortoleva et al. sheds additional light onto this difficult area of study. Recently, Huang et al. investigated the role of right ventricular function in cardiogenic shock patients receiving VA ECMO support. They reported volumetric analysis of 3-dimensional echocardiographyÀderived right ventricular ejection fraction in 46 patients before weaning VA ECMO support and concluded that right ventricular ejection fraction <24.6% was independently associated with failure to wean and a higher