While ECMO supports systemic circulation in cardiogenic shock, it can increase left ventricular afterload, highlighting the potential need for left atrial decompression to prevent pulmonary edema.
May warrant left atrial decompression in select ECMO cases with edema; leaves open optimal strategies for prospective trials.
The treatment of cardiogenic shock using inotropic agents and vascular volume expansion places an added burden on the heart. The resultant increase in cardiac work may cause myocardial ischemia and lead to cardiac arrest. Extracorporeal membrane oxygenation (ECMO) may be used to treat cardiogenic shock. It supports systemic circulation, assures diastolic perfusion of the myocardium, and reduces cardiac workload. The rise in blood pressure associated with restoring systemic circulation afterloads the heart and can cause left atrial hypertension and pulmonary edema. ECMO does not automatically reduce cardiac work, especially in the presence of residual shunts. Left atrial drainage or decompression may be essential in certain patients both to avert pulmonary edema and to reduce cardiac work.
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Fuhrman et al. (1999) studied this question.
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