CHARACTERISTICS AND ASSOCIATED FACTORS OF LEFT VENTRICULAR OVERLOAD IN VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION

Abstract

Background: Peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) is a common choice for managing patients with circulatory shock that is refractory to optimal medical treatment. Despite its benefits in restoring organ perfusion, left ventricular overload (LVO) due to retrograde blood flow remains a major concern. The characteristics of this complication along with associated factors and patient treatment outcome have been focused on in previous studies.

Objective: To describe the incidence of LVO in patients supported with VA ECMO and explore the associated factors.

Methods: This observational study was conducted on adult patients in the Critical Care Department of Cho Ray Hospital who were supported with VA ECMO. Left ventricular overload diagnostics were based on a pulse pressure of ≤ 15 mmHg, an AV VTI of ≤ 5 cm, and echocardiographic signs suggesting sluggish blood flow in the left ventricle.

Results: Left ventricular overload occurred in 31 out of 79 patients (39.2%), with a gradually increasing incidence peaked on the fifth day of treatment. Multivariate regression analysis revealed that time from onset to admission (days, OR = 1.62; 1.16 – 2.48), arrhythmias (OR = 16.86; 3.46 – 130.36), mitral regurgitation before ECMO (OR = 3.92; 1.08 – 16.73), and acute myocarditis (OR = 7.94; 1.25 – 80.09) were independently associated with left ventricular overload.

Conclusion: Left ventricular overload is a common complication that develops over time in peripheral VA ECMO patients. Close monitoring for this complication, especially those with diagnostic factors, and planned interventions are crucial for effective management.

Keywords: left ventricular overload; extracorporeal membrane oxygenation; circulatory shock