Veno-Pulmonary Arterial Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome: Should We Consider Mechanical Support of the Pulmonary Circulation From the Outset?

Zochios, Vasileios; Yusuff, Hakeem; Antonini, Marta Velia; Schmidt, Matthieu; Shekar, Kiran

doi:10.1097/mat.0000000000001930

Cited by 14 publications

(4 citation statements)

References 37 publications

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“…Historically, when RV failure persisted or worsened with V-V ECMO despite RV protective ventilation ( 15 ), conversion to V-A or V-A-V ECMO was considered the standard rescue strategy ( 17 , 38 ). The theoretical advantage of V-P ECMO over the conventional one is its lower recirculation, which should potentially enhance oxygenation ( 39 ). Third, ARDS etiology was COVID-19 in half of our patients, and severe acute chest syndrome in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…An innovative approach redesigning the ProtekDuo cannula as a double lumen return cannula supplemented by a femoral drainage cannula, has been described ( 35 , 44 ) to offer higher blood flows (up to 7 liters per minute) and to improve oxygenation ( 35 , 44 ). On the other hand, a high blood flow can also be achieved with a dual-site V-P ECMO strategy ( 35 , 36 , 39 , 44 ). Other complications were reported on the ProtekDuo ( 28 , 37 ), like intracannula thrombosis ( 45 ), right coronary artery compression ( 46 ), severe tricuspid regurgitation ( 47 ), and superior vena cava syndrome ( 48 ), yet none occurred in our patients.…”

Section: Discussionmentioning

confidence: 99%

“…Our preliminary data support the feasibility of initiating V-P ECMO in patients with refractory ACP on conventional ECMO. The precise indications of this technique warrant further research ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

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Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist—a case series

Bagate,

Masi,

Boukantar

et al. 2024

Front. Med.

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IntroductionPulmonary vascular dysfunction during severe acute respiratory distress syndrome (ARDS) may lead to right ventricle (RV) dysfunction and acute cor pulmonale (ACP). The occurrence/persistence of ACP despite conventional extracorporeal membrane oxygenation (ECMO) is a challenging situation. We explored the usefulness of a specific dual-lumen cannula that bypasses the RV, and on which a veno-pulmonary arterial assist (V-P ECMO) was mounted, in ARDS patients.MethodsWe report a case-series of ARDS patients put on conventional veno-arterial or veno-venous ECMO and presented refractory ACP as an indication for a reconfiguration to V-P ECMO using the ProtekDuo cannula. The primary endpoint was the mitigation of RV and pulmonary vascular dysfunction as assessed by the change in end-diastolic RV/left ventricle (LV) surface ratio.ResultsSix patients had their conventional ECMO reconfigured to V-P ECMO to treat refractory ACP. There was a decrease in end-diastolic RV/LV surface ratio, as well as end-systolic LV eccentricity index, and lactatemia immediately after V-P ECMO initiation. The resolution of refractory ACP was immediately achieved in four of our six (66%) patients. The V-P ECMO was weaned after a median of 26 [8–93] days after implantation. All but one patient were discharged home. We detected one case of severe hemolysis with V-P ECMO and two suspected cases of right-sided infective endocarditis.ConclusionV-P ECMO is useful to mitigate RV overload and to improve hemodynamics in case of refractory ACP despite conventional ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist—a case series

Bagate,

Masi,

Boukantar

et al. 2024

Front. Med.

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“…In this scenario, LV distension is a serious threat that could further compromise the residual myocardial function and lead to apical thrombosis [28]. Moreover, when RV performance is also affected, the antegrade blood flow across the lungs is limited during the ECMO cannulation, resulting in reduced pulmonary perfusion [29].…”

Section: Discussionmentioning

confidence: 99%

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

Tarzia,

Ponzoni,

Pittarello

et al. 2023

JCM

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Background: When heart transplantation and myocardial recovery are unlikely, patients presenting with biventricular cardiogenic shock initially treated with extracorporeal membrane oxygenation (ECMO) may benefit from a mechanical support upgrade. In this scenario, a micro-invasive approach is proposed: the combination of the double-lumen ProtekDuo cannula (Livanova, London, UK) and the Impella 5.5 (Abiomed, Danvers, MA) trans-aortic pump that translates into a hybrid BiVAD. Methods: All consecutive ECMO patients presenting with biventricular cardiogenic shock and ineligibility to heart transplantation from August 2022 were prospectively enrolled. The clinical course, procedural details, and in-hospital events were collected via electronic medical records. Results: A total of three patients, who were temporarily not eligible for heart transplantation or durable LVAD due to severe acute pneumonia and right ventricular (RV) dysfunction, were implanted with a hybrid BiVAD. This strategy provided high-flow biventricular support while pulmonary function ameliorated. Moreover, by differentially sustaining the systemic and pulmonary circulation, it allowed for a more adequate reassessment of RV function. All the patients were considered eligible for isolated durable LVAD and underwent less invasive LVAD implantation paired with a planned postoperative RVAD. In all cases, RV function gradually recovered and the RVAD was successfully removed. Conclusions: The Hybrid BiVAD represents an up-to-date micro-invasive mechanical treatment of acute biventricular failure beyond ECMO. Its rationale relies on more physiological circulation across the lungs, the complete biventricular unloading, and the possibility of including an oxygenator in the circuit. Finally, the independent and differential control of pulmonary and systemic flows allows for more accurate RV function evaluation for isolated durable LVAD eligibility reassessment.

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Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation

Douflé,

Dragoi,

Morales Castro

et al. 2024

Intensive Care Med

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Veno-Pulmonary Arterial Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome: Should We Consider Mechanical Support of the Pulmonary Circulation From the Outset?

Cited by 14 publications

References 37 publications

Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist—a case series

Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist—a case series

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation

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