Severe right heart failure is typically managed using external right ventricular assist devices (RVADs) or inotropic agents while awaiting heart transplantation. Here, we report a successful case using an implantable RVA...Severe right heart failure is typically managed using external right ventricular assist devices (RVADs) or inotropic agents while awaiting heart transplantation. Here, we report a successful case using an implantable RVAD to treat end-stage right-sided heart failure caused by arrhythmogenic right ventricular cardiomyopathy.
Severe right ventricular failure (RVF) is a morbid complication of left ventricular assist device insertion. The optimal timing of right ventricular assist device (RVAD) support remains controversial. We sought to evalua...Severe right ventricular failure (RVF) is a morbid complication of left ventricular assist device insertion. The optimal timing of right ventricular assist device (RVAD) support remains controversial. We sought to evaluate outcomes associated with preemptive versus delayed RVAD insertion at the time of HeartMate 3 (HM3) implantation. We retrospectively reviewed 293 patients who underwent HM3 implantation between November 2014 and December 2022. A preemptive RVAD strategy was applied to select patients. Outcomes were compared to patients who did not require an RVAD and who required an RVAD after HM3 insertion (reactive RVAD). Thirty-three patients (11.3%) underwent preemptive RVAD insertion, whereas 229 (78.2%) had no RVAD, and 31 (10.5%) had a reactive RVAD. Reasons for preemptive RVADs were cardiogenic shock (n = 22, 66.7%), severe biventricular failure (n = 7, 21.2%), or refractory ventricular tachycardia (n = 4, 12.1%). In-hospital mortality was highest in the reactive group (None: 2.2 versus Preemptive: 3.0 versus Reactive: 25.8%, p < 0.001). Kaplan-Meier analysis showed the lowest 3 year survival in the reactive group, whereas the preemptive and non-RVAD groups had comparable survival rates (83.5% vs. 85.5% vs. 46.6%, p < 0.001). In multivariable Cox analysis, reactive RVAD was an independent risk factor for mortality (hazard ratio [HR]: 2.7, p < 0.001). In our study, preemptive RVAD insertion was associated with improved outcomes.
In this case of a patient bridged to simultaneous heart-kidney transplant (SHKT) with an Impella 5.5, the device was preserved following heart transplant (HT) to provide mechanical support and facilitate kidney transplan...In this case of a patient bridged to simultaneous heart-kidney transplant (SHKT) with an Impella 5.5, the device was preserved following heart transplant (HT) to provide mechanical support and facilitate kidney transplantation in the same operative encounter with the goal of reducing delayed kidney graft function. Our patient is a 60 year old man initially listed with status 5 for a combined heart/kidney transplant. Due to worsening hemodynamics and rising creatinine, a right axillary Impella 5.5 was inserted. The patient underwent a bicaval SHKT. During the aortic anastomosis, the Impella was repositioned across the aortic valve. The kidney was transplanted in the same encounter. The patient left the operating room (OR) on vasopressors, inotropes, and Impella support. There was immediate production of urine without needing renal replacement (RRT). The Impella was removed on postoperative day 4, and inotropes were discontinued by day 7. He produced more than 2.5 L of urine daily, with creatinine peaking at 2.39 mg/dl and ending at 0.9 mg/dl. He was discharged on postoperative day 15 and was seen as an outpatient with excellent graft function. Leaving the Impella for temporary support allowed for a kidney transplant in the same operative encounter, early mobilization, reduction of vasoactive agents, and may have reduced the risk of delayed graft function and need for RRT. 1) Scientific Image and Illustration Software. Central Image Heart Animation. BioRender. Accessed February 21, 2025. https://www.biorender.com/ . 2) Abiomed J&J MedTech. Central Image Impella 5.5 Animation. Accessed February 21, 2025. https://www.abiomed.com/en-us/patients-and-caregivers/about-impella .
Acute decompensated heart failure (ADHF) and acute myocardial infarction (AMI) are major etiologies of cardiogenic shock with distinct pathophysiology. This study reported the outcomes of venoarterial extracorporeal life...Acute decompensated heart failure (ADHF) and acute myocardial infarction (AMI) are major etiologies of cardiogenic shock with distinct pathophysiology. This study reported the outcomes of venoarterial extracorporeal life support (V-A ECLS) between ADHF cardiogenic shock (ADHF-CS) and AMI cardiogenic shock (AMI-CS), including 233 patients. Outcomes were compared between patients with ADHF-CS and AMI-CS. Additionally, we classified each study cohort into two groups based on the date of cannulation to V-A ECLS before and after the United Network for Organ Sharing (UNOS) policy change and compared outcomes. There were 107 ADHF-CS patients and 126 AMI-CS patients. A Kaplan-Meier 1 year survival probability of ADHF-CS group was 51.8%, while the AMI-CS group had a 1 year survival probability of 29.2% (p = 0.001). However, the difference in 1 year survival is no longer observed after inverse probability of treatment weighting (IPTW) (37.5% vs. 27.0%, p = 0.28). Regarding myocardial recovery and bridging modality, bridge to recovery or ventricular assist device rate was similar between groups, whereas bridge to transplant rate was significantly higher in the ADHF-CS than AMI-CS after IPTW (3.5% vs. 0.0%, p = 0.010). This trend became particularly evident following the change in the UNOS allocation system.
Extracorporeal carbon dioxide removal (ECCO₂R) prevents intubation and facilitates extubation in patients with hypercapnic respiratory failure. However, low-flow systems increase shear stress and need full anticoagulatio...Extracorporeal carbon dioxide removal (ECCO₂R) prevents intubation and facilitates extubation in patients with hypercapnic respiratory failure. However, low-flow systems increase shear stress and need full anticoagulation, increasing the risk of circuit-related complications. We assessed the safety and efficacy of a high-caliber dual-lumen cannula, designed for jugular veno-venous extracorporeal membrane oxygenation (VV ECMO), repurposed for femoral vein insertion, with the aim of achieving higher blood-flow rates and more efficient CO₂ clearance. We retrospectively analyzed 16 intensive care unit (ICU) patients (62 years; 81% chronic obstructive pulmonary disease [COPD]) treated with ECCO₂R using a large-caliber dual-lumen cannula (20-23 Fr) inserted via the femoral vein. Key outcomes included changes in gas exchange, ventilatory support status, and complications. Extracorporeal carbon dioxide removal enabled rapid CO₂ clearance, with arterial carbon dioxide pressure (PaCO₂) decreasing from 68 [62-95] to 49 [45-56] mm Hg at 2 h, and pH increasing from 7.20 [7.16-7.27] to 7.36 [7.33-7.41]. Fifty-six percent of patients avoided intubation, whereas all intubated patients were extubated during ECCO₂R. The median support duration was 5 [4-7] days. No hemolysis was documented. One bleeding episode and one clotting event occurred; no thrombotic or cannulation-related complications were observed. Femoral vein cannulation with a large-caliber dual-lumen cannula for ECCO₂R appears feasible and safe. This strategy may offer technical and clinical advantages over conventional ECCO₂R systems, warranting prospective investigation.
Hemocompatibility adverse events are frequent in critically ill patients on microaxial flow pump (mAFP) support. Promising experience has accumulated on the use of primary direct thrombin inhibitor (DTI) for anticoagulat...Hemocompatibility adverse events are frequent in critically ill patients on microaxial flow pump (mAFP) support. Promising experience has accumulated on the use of primary direct thrombin inhibitor (DTI) for anticoagulation in temporary mechanical circulatory support (tMCS). The aim of the study was to compare DTI-based with heparin-based anticoagulation in cardiogenic shock (CS) patients on mAFP. We collected data from 180 adult CS patients supported with mAFP at two referral centers from 2018 to 2023. Patients received primary intravenous anticoagulation with heparin (n = 85, 47%) or bivalirudin (n = 95, 53%) according to institutional protocols. The inverse probability weighting (IPWT) was used to balance treatment groups. Society of Cardiovascular and Angiography Interventions (SCAI) class at mAFP implantation was C in 73 (41%) patients, D in 80 (44%), E in 20 (11%). Impella CP was the most implanted mAFP (85 patients, 47%), followed by Impella 5.5 (65, 36%), Impella 5.0 (28, 16%), and Impella 2.5 (2, 1%). The bleeding rate was 27%, and the thrombosis rate was less than 10%. At IPWT, clinical (overall, major and minor bleeding, major and minor hemolysis) and survival outcomes were comparable. Patients in the DTI group had fewer aPTT variations of greater than 20% and aPTT values exceeding 80 seconds ( p < 0.001). In the largest available study performed in mAFP patients, DTI for anticoagulation was comparable to heparin with a possibly more stable effect on aPTT.
Extracorporeal membrane oxygenation (ECMO) use during liver transplantation is a complex and evolving aspect of critical care. This retrospective analysis presents the largest North American case series to date, offering...Extracorporeal membrane oxygenation (ECMO) use during liver transplantation is a complex and evolving aspect of critical care. This retrospective analysis presents the largest North American case series to date, offering a detailed comparison of survival outcomes in liver transplant (LT) patients supported by ECMO. A total of 15 patients were supported with ECMO, eight were supported on venoarterial (VA) ECMO and the remaining seven on venovenous (VV) ECMO. The median duration of ECMO support was 10 days. Mean intensive care unit (ICU) and hospital stays were 34.8 (interquartile range [IQR]: 1-158) and 49.2 days (IQR: 1-121), respectively. Overall survival was 33.3%, comparable to published rates (20-30%). Survival was based on ECMO initiation timing: preoperative 33.3% (1/3); intraoperative 50% (3/6); postoperative, 16.6% (1/6). All the patients (five) discharged from hospital were alive at 1 year follow-up. Significant ECMO-related complications included acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) (40%, n = 6/15), neurological complications (40%, n = 6/15), and bleeding requiring transfusion (26.6%, n = 4/15). Literature review suggests better outcomes with intraoperative or postoperative ECMO. While ECMO use is increasing in LT, outcomes remain poor. Improved survival may depend on careful patient selection, optimal timing of initiation, and distinguishing reversible pathology from irreversible one.
Extracorporeal membrane oxygenation (ECMO) is now commonly used to manage refractory pediatric cardiac or respiratory failure. Traditionally, ECMO has been associated with high morbidity. However, despite advancements in...Extracorporeal membrane oxygenation (ECMO) is now commonly used to manage refractory pediatric cardiac or respiratory failure. Traditionally, ECMO has been associated with high morbidity. However, despite advancements in ECMO techniques, little has been reported about the improvement of ECMO survivors' functional status. In this single-center retrospective case-control study, we compared noncardiac ECMO patients and propensity-score-matched controls' functional outcomes using the functional status score (FSS). Our main outcome of interest was the change of FSS between admission and discharge, using a threshold of FSS change greater than or equal to 3 or those who crossed between two functional groups as a clinically significant change. Eighty-one patients were paired in the ECMO versus non-ECMO survivors. At discharge, we found the difference between the median FSS scores of the cohort not statistically significant (10 vs . 8, p = 0.95). Similarly, using our predetermined cut-off of FSS change of greater than or equal to 3 or those crossing two functional groups, we found no difference between the two cohorts (odds ratio [OR]: 1.9, p = 0.052, OR: 1.71, p = 0.15). Our findings suggest that functional outcomes of noncardiac ECMO survivors may be comparable to those of patients managed without ECMO.
Calcium channel blocker (CCB) toxicity can lead to cardiogenic shock and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy when conventional treatments fail, but outcomes d...Calcium channel blocker (CCB) toxicity can lead to cardiogenic shock and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) has been used as salvage therapy when conventional treatments fail, but outcomes data-especially comparing pediatric and adult populations-are limited. We conducted a retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry from 2015 to 2023, identifying 157 patients aged greater than or equal to 28 days with CCB toxicity. The primary outcome was survival to discharge. Univariate logistic regression identified survival-associated factors. Overall survival was higher in pediatric patients, compared to adults (80% vs. 63%, p = 0.0536). Veno-arterial ECMO was used in 90% of cases. Extracorporeal membrane oxygenation use increased over time without a decrease in survival. Higher age (1 year increase: odds ratio [OR] = 0.97/year, 95% confidence interval [CI]: 0.95-0.99) and lower arterial pH (per 0.1 pH increase, OR = 1.39, 95% CI: 1.04-1.86) had lower unadjusted odds of survival. The presence of pre-ECMO cardiac arrest (OR = 0.29, 95% CI: 0.12-0.65) and use of extracorporeal cardiopulmonary resuscitation (CPR) (OR = 8.27, 95% CI: 1.91-57) had lower unadjusted odds of survival. Extracorporeal membrane oxygenation is increasingly used as a rescue therapy for severe CCB toxicity. Factors such as younger age, preserved pH, and absence of cardiac arrest before cannulation are associated with improved outcomes.
We assessed characteristics and risk factors of gastrointestinal (GI) bleeding in patients with continuous-flow left ventricular assist devices (CF-LVAD) in our institutional Intermacs database (2008-2023). Patient chara...We assessed characteristics and risk factors of gastrointestinal (GI) bleeding in patients with continuous-flow left ventricular assist devices (CF-LVAD) in our institutional Intermacs database (2008-2023). Patient characteristics were reported as frequencies/proportions for categorical variables and as median/interquartile range (IQR) for continuous variables. Multivariable Cox proportional hazards regression identified GI bleeding risk factors. Among 1,030 CF-LVADs implanted, the median age was 58.5 years (IQR: 50.4-65.4), and 79.4% were male. Pre-implant Intermacs profile less than or equal to 3 was seen in 80.6%. Axial-flow LVADs were used in 55.2%, partially magnetically levitated centrifugal-flow in 30.7%, and fully magnetically levitated centrifugal-flow in 14.1%. GI bleeding occurred in 37.5% (13.9 per 100 person-years), with 65.3% rebleeding. Bleeding sources: 54.4% upper GI, 21.8% lower GI, and 23.8% unknown. The median time from LVAD implant to first GI bleeding was 5 months (IQR: 1-19); to any GI bleeding was 11 months (IQR: 2-31). Patients older than 50 years were three times more likely to develop GI bleeding (hazard ratio [HR]: 3.15, p < 0.001). Fully magnetically levitated centrifugal-flow LVADs reduced GI bleeding risk by four times compared to axial-flow LVADs (HR: 0.26, p < 0.001). Coronary artery disease (HR: 1.49, p = 0.022) and chronic kidney disease (HR: 1.91, p = 0.001) nearly double the risk of GI bleeding.
This retrospective cohort study evaluates the validity of the Renal Angina Index (RAI) in predicting acute kidney injury (AKI) in 272 patients receiving extracorporeal membrane oxygenation (ECMO) support. The findings sh...This retrospective cohort study evaluates the validity of the Renal Angina Index (RAI) in predicting acute kidney injury (AKI) in 272 patients receiving extracorporeal membrane oxygenation (ECMO) support. The findings show that 56.9% of patients present with renal angina. This condition is significantly associated with the use of vasoactive agents like norepinephrine (odds ratios [OR]: 4.54; 95% confidence interval [CI], 2.42-8.53; p < 0.001), oxygen debt (OR: 1.15; 95% CI, 1.03-1.07; p < 0.001), veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy (OR: 3.99; 95% CI, 2.14-7.40; p < 0.001), and pre-ECMO potassium levels (OR: 3.14; 95% CI, 2.05-4.82; p < 0.001). Ultimately, 81.9% of patients develop AKI, 50.3% require renal replacement therapy (RRT), and 41.3% die. The RAI demonstrates a good predictive ability for developing AKI, with an area under the receiver operating characteristic curve (AUROC) of 0.756 (95% CI, 0.70-0.80). Its performance is moderate for predicting AKI severity progression (AUROC: 0.604) and the need for RRT (AUROC: 0.615). The authors conclude that RAI is a reliable and practical early clinical tool to identify ECMO patients at high risk for AKI and its complications.
Mobilization of patients supported on extracorporeal membrane oxygenation (ECMO)-especially with femoral cannulas-presents unique challenges. This single-center retrospective cohort study aims to assess the efficacy and...Mobilization of patients supported on extracorporeal membrane oxygenation (ECMO)-especially with femoral cannulas-presents unique challenges. This single-center retrospective cohort study aims to assess the efficacy and safety of mobilizing these patients using a specialized, fully vertically tilting bed. All adult (≥ 18 years) patients receiving ECMO for greater than or equal to 48 hours from January 2018 to December 2019 who were placed on the tilt bed were compared with those who were not. Of the 152 included patients, 24 (15.8%) were placed on the tilt bed and underwent 124 physical therapy (PT) sessions, whereas 42 (32.8%) others participated in 183 non-tilt bed PT sessions. Tilt bed patients were younger (46.4 [38.1-48.9] vs. 55.9 [42.8-65.8] years, p = 0.002) and more likely to be on ECMO as a bridge to decision/transplant (54.1% vs . 20.3%, p < 0.001). Despite significantly longer durations of ECMO support (20 [13-30] vs . 8 [4-16] days, p < 0.001), tilt bed patients achieved mobility milestones at comparable timepoints following decannulation (standing: 3 [2-6] vs . 5 [3-11] days, p = 0.08; ambulation: 10 [5-17] vs. 7 [3-20] days, p = 0.81). Minor adverse events occurred during 15.2% of tilt bed sessions with no serious adverse events. Tilt beds may provide a safe and effective modality to facilitate the mobilization of ECMO patients.
Nemeh C, Dantes G, Cain-Trivette C
… +11 more, Steklac K, Schmoke N, Jessup HR, Kirilina D, Kurlansky P, Varner C, Brewer M, Clark E, Middlesworth W, Linden AF, Cheung EW
Extracorporeal membrane oxygenation (ECMO) can provide an option for high-risk procedures that may result in cardiopulmonary collapse. The indications for ECMO standby are not well delineated. We describe the experiences...Extracorporeal membrane oxygenation (ECMO) can provide an option for high-risk procedures that may result in cardiopulmonary collapse. The indications for ECMO standby are not well delineated. We describe the experiences of pediatric ECMO standby at two high-volume centers. A retrospective review of pediatric ECMO standby from 2016 to 2023 was performed (n = 394). Data regarding the locations of ECMO standby and the types of procedures were obtained. The primary outcome evaluated was requiring ECMO cannulation during standby. Of the 394 pediatric patients, only 8 (2%) required ECMO cannulation during standby. The indications for ECMO standby were cardiac (84%) and respiratory (16%) complications. Standby locations included the cardiac catheterization suite (55.6%), the operating room (OR) (20.6%), the intensive care unit (ICU) (11.9%), and the interventional radiology (IR) suite (11.9%). Standby within the cardiac catheterization suite included diagnostic only (53%) and interventional (47%), of which 0 and 4 (3.9%) patients required ECMO, respectively. Procedures in OR, IR, or ICU consisted of major surgical procedures (14%), minimally invasive minor procedures (64%), intubations (18%), and transfers/births (4%). Few ECMO standby patients require cannulation; however, it is complicated to predict patient decompensation. Further studies are warranted to delineate which patients would benefit from ECMO standby while balancing cost and resource utilization.
Previously, limited cumulative experience has been linked to poor transplantation outcomes following ex vivo lung perfusion (EVLP). We sought to determine if EVLP performed at external perfusion centers (EPC) could mitig...Previously, limited cumulative experience has been linked to poor transplantation outcomes following ex vivo lung perfusion (EVLP). We sought to determine if EVLP performed at external perfusion centers (EPC) could mitigate this effect. Recipients from the United Network for Organ Sharing Database were stratified into: high-volume transplant program (HV-TP), low-volume transplant program (LV-TP), and EPC, based on who performed EVLP. Comparative statistics and Kaplan-Meier survival analysis were used, with a multivariable Cox regression model identifying independent mortality risk factors. A subgroup analysis compared LV transplant centers using EPCs (LV-EPC) against HV-TP recipients. The LV-TP group had a significantly higher incidence of postoperative ECMO use (20.8%, p = 0.009) and primary graft dysfunction grade 3 (PGD3) (30.1%, p = 0.011). However, survival did not significantly differ between groups, and LV-TP was not independently associated with increased mortality. Subgroup analysis showed that the LV-EPC had significantly shorter hospital stay when compared with HV-TP (20.5 vs. 24 days, p = 0.01) and equivocal rates of PGD3 ( p = 0.204), with no survival or independent mortality difference on multivariable analysis. External perfusion centers can mitigate postoperative complications associated with LV transplant centers. For centers with limited EVLP experience, EPCs offer a viable alternative pathway to expand the donor pool.
Accurate survival prediction in peritoneal dialysis (PD) patients is essential for personalized treatment planning and shared decision-making. We developed and validated PD-PREDICT, an XGBoost-based model to generate dyn...Accurate survival prediction in peritoneal dialysis (PD) patients is essential for personalized treatment planning and shared decision-making. We developed and validated PD-PREDICT, an XGBoost-based model to generate dynamic mortality risk estimates in incident PD patients. We conducted a retrospective cohort study using data from the UK Renal Registry (UKRR), comprising 22,711 incident PD patients treated between January 1, 2007, and September 1, 2022. The development cohort (n = 14,650; January 2007-December 2016) was split into training and internal test sets. Temporal validation employed an independent UKRR cohort (n = 8,061; January 2017-December 2021). External validation used 2,180 patients from the Norwegian Renal Registry. Model performance was assessed by Harrell's concordance index ( C index), Integrated Brier Score (IBS), decision curve analysis, and 50 iteration bootstrap for C index stability. In the development cohort, PD-PREDICT achieved a training C index of 0.83 and test C index of 0.81 (IBS: 0.09). The decision tree baseline model yielded a test C index of 0.78 (IBS: 0.13). Bootstrap analysis confirmed C index stability (0.81; 95% confidence interval [CI], 0.79-0.83). Temporal validation produced a C index of 0.80, and external validation in Norway yielded 0.77. PD-PREDICT provides robust, dynamic mortality risk predictions for PD patients, outperforming traditional methods and maintaining accuracy across temporal and geographic validations.
The continuous flow left ventricular assist devices (CFVAD) were designed for bridge-to-transplant therapy (BTT). We evaluated their overall impact on end-stage heart failure survival (before and after transplant) using...The continuous flow left ventricular assist devices (CFVAD) were designed for bridge-to-transplant therapy (BTT). We evaluated their overall impact on end-stage heart failure survival (before and after transplant) using the United Network for Organ Sharing (UNOS) database from 2005 to 2024 for adult patients. The patients were divided into groups based on CFVAD use and age > or ≤50 years. A composite survival was calculated by the addition of waitlist duration, prelisting CFVAD duration (for CFVADs only), and post-transplant (for transplanted patients only) survival. A total of 55,468 patients were listed, 18,930 had CFVADs and 36,538 had no mechanical circulatory support (MCS). A logistic regression model identified male gender, Black race, blood group O, noncongenital cardiomyopathy, and younger age as factors associated with increased CFVAD use. In patients with a higher likelihood of CFVAD use, composite survival at 1 year was significantly better with CFVAD (93% vs . 81%). In patients <50 years, use of CFVAD showed better 5 year composite survival compared with no-MCS and patients older than 50 years (95% vs . 92%, 85%, 84% p < 0.01, F4). In conclusion, use of CFVAD for BTT, particularly in younger patients has overall composite survival advantage compared with no-MCS patients. More eligible patients should be implanted with CFVAD before transplant to maximize their overall heart failure survival.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers cardiopulmonary support with the tradeoff of increased left ventricular (LV) afterload and its adverse sequelae. LV decompression strategies include the u...Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers cardiopulmonary support with the tradeoff of increased left ventricular (LV) afterload and its adverse sequelae. LV decompression strategies include the use of intra-aortic balloon pump (IABP), indirect LV venting (pulmonary artery cannula [PAC] venting), left atrial venting, and direct LV venting with microaxial flow pump (mAFP). This is a single-institution retrospective study investigating the effect of LV unloading in patients undergoing peripheral VA-ECMO for cardiogenic shock over the study period, January 2017 to November 2022. A total of 184 patients received VA-ECMO support. LV venting/decompression was used in 78 patients (patient underwent an LV venting/decompression strategy [LV+]: 17 IABP, 51 mAFP, 5 PAC vent). Among the LV+ patients, 36 patients received venting before initiation or within 24 hours after initiation of VA-ECMO (early, eLV+), whereas 35 patients were vented greater than 24 hours after VA-ECMO initiation (delayed, dLV+). Post-ECMO diastolic pulmonary artery pressure was similar between vented and unvented groups (p = 0.367) despite worse baseline cardiac function in the vented group (ejection fraction [EF] 25%). LV venting/decompression strategies had similar ECMO-related complication rates to non-vented patients. Patients who received IABP with ECMO (of whom the majority were in the eLV+ group ) had an improved post-decannulation survival relative to other venting strategies.
Left ventricular assist device (LVAD)-supported patients experiencing electrical storm (ES) and cardiac arrest present unique management challenges. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is commonl...Left ventricular assist device (LVAD)-supported patients experiencing electrical storm (ES) and cardiac arrest present unique management challenges. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is commonly used for extracorporeal cardiopulmonary resuscitation (ECPR), but its application in LVAD-supported patients presents hemodynamic complexities. Alternative ECMO modes, including venopulmonary (VP) and hybrid venoarteriopulmonary (VAP) ECMO, may provide tailored circulatory and respiratory support in select cases. This case report describes a patient with a newly implanted LVAD who developed ES, refractory right ventricular failure, and cardiac arrest. The patient underwent staged ECMO support, transitioning from VA ECMO for ECPR to hybrid VAP ECMO and ultimately to VP ECMO, based on evolving hemodynamic needs.