Left Ventricular Distension in Veno-arterial Extracorporeal Membrane Oxygenation: From Mechanics to Therapies

Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is increasingly commonly used to treat acute cardiac or pulmonary failure because of a wide range of etiologies. However, despite progressively improving outcomes, the mortality associated with V-A ECMO, particularly when used to treat cardiac failure (its most common indication), continues to be high. Consistent with this, V-A ECMO is associated with numerous morbid complications. Left ventricular (LV) distension is a major complication of V-A ECMO, and is challenging both to treat and diagnose. The author review the pathophysiology underlying LV distension, and construct a systematic diagnostic and therapeutic approach.