LAVA-ECMO has recently gained attention in the medical community, specifically, as support for cardiogenic-shock patients. In particular, interest has picked up since it was highlighted at the 2023 Houston Shock Symposium.

LAVA-ECMO refers to the use of left atrial venoarterial cannulation during extracorporeal membrane oxygenation. That is, left atrial VA-ECMO. Patients with severe cardiogenic shock need mechanical-respiratory and hemodynamic support with VA ECMO. However, this treatment can increase the mechanical load on the left ventricle which may worsen pulmonary edema and make cardiac recovery more challenging.

Unloading the left ventricle (LV) during VA-ECMO can mitigate some of these risks. Typically, this is done with temporary mechanical circulatory support like an intra-aortic balloon pump or a percutaneous left ventricular assist device.  

LAVA-ECMO, on the other hand, “involves placement of a left-atrial drainage catheter that is placed via interatrial transseptal puncture. This would allow for direct left atrial drainage, thereby reducing pulmonary capillary wedge pressure and left ventricular preload thereby unloading the LV.”