PMID- 31795624
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2586-6060 (Electronic)
IS  - 2586-6052 (Print)
IS  - 2586-6052 (Linking)
VI  - 34
IP  - 4
DP  - 2019 Nov
TI  - How small is enough for the left heart decompression cannula during 
      extracorporeal membrane oxygenation?
PG  - 263-268
LID - 10.4266/acc.2019.00577 [doi]
AB  - BACKGROUND: Left ventricular (LV) distension is a recognizable problem 
      accompanied by subsequent complications during venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO). However, no gold standard for LV decompression 
      has been established, and no minimal flow requirement has been designated. Thus, 
      we evaluated the efficacy of the 8-Fr Mullins sheath for left heart decompression 
      during VA-ECMO in adult patients. METHODS: Left heart decompression was performed 
      when severe pulmonary edema was detected on chest radiography or when no 
      generation of pulse pressure followed severe LV dysfunction in patients receiving 
      VA-ECMO. We punctured the interatrial septum and inserted an 8-Fr Mullins sheath 
      into the left atrium via the femoral vein. The sheath was connected to the venous 
      catheter used for ECMO. The catheter was maintained during VA-ECMO. RESULTS: The 
      left heart decompression procedure was performed in seven of 35 patients who 
      received VA-ECMO between February 2017 and June 2018. Three patients had acute 
      myocardial infarction; three, fulminant myocarditis; and one, dilated 
      cardiomyopathy. Four patients showed noticeable improvement of pulmonary edema 
      within 3 days, and three patients with a pulse pressure of <10 mm Hg showed an 
      increase in pulse pressure of >20 mm Hg within 24 hours from the left heart 
      decompression procedure. All seven patients were successfully weaned from 
      VA-ECMO. No complications related to the left heart decompression procedure 
      occurred. CONCLUSIONS: An 8-Fr sheath may be a possible option for left heart 
      decompression in adult patients with LV distension under VA-ECMO who are 
      expecting recovery of LV function.
FAU - Kim, Sua
AU  - Kim S
AD  - Department of Critical Care Medicine, Korea University Ansan Hospital, Korea 
      University College of Medicine, Ansan, Korea.
AD  - Division of Cardiology, Department of Internal Medicine, Korea University Ansan 
      Hospital, Korea University College of Medicine, Ansan, Korea.
FAU - Kim, Jin Seok
AU  - Kim JS
AD  - Division of Cardiology, Department of Internal Medicine, Korea University Ansan 
      Hospital, Korea University College of Medicine, Ansan, Korea.
FAU - Shin, Jae Seung
AU  - Shin JS
AD  - Department of Thoracic and Cardiovascular Surgery, Korea University Ansan 
      Hospital, Korea University College of Medicine, Ansan, Korea.
FAU - Shin, Hong Ju
AU  - Shin HJ
AD  - Department of Thoracic and Cardiovascular Surgery, Korea University Ansan 
      Hospital, Korea University College of Medicine, Ansan, Korea.
LA  - eng
PT  - Journal Article
DEP - 20191129
PL  - Korea (South)
TA  - Acute Crit Care
JT  - Acute and critical care
JID - 101726905
PMC - PMC6895469
OTO - NOTNLM
OT  - extracorporeal membrane oxygenation
OT  - left heart decompression
OT  - left ventricular distension
COIS- CONFLICT OF INTEREST No potential conflict of interest relevant to this article 
      was reported.
EDAT- 2019/12/05 06:00
MHDA- 2019/12/05 06:01
PMCR- 2019/11/01
CRDT- 2019/12/05 06:00
PHST- 2019/05/30 00:00 [received]
PHST- 2019/11/04 00:00 [accepted]
PHST- 2019/12/05 06:00 [entrez]
PHST- 2019/12/05 06:00 [pubmed]
PHST- 2019/12/05 06:01 [medline]
PHST- 2019/11/01 00:00 [pmc-release]
AID - acc.2019.00577 [pii]
AID - acc-2019-00577 [pii]
AID - 10.4266/acc.2019.00577 [doi]
PST - ppublish
SO  - Acute Crit Care. 2019 Nov;34(4):263-268. doi: 10.4266/acc.2019.00577. Epub 2019 
      Nov 29.