Skip to main content
  • Editorial: To Vent or Not to Vent: The Critical Role of Left Ventricular Venting With Extracorporeal Membrane Oxygenation Support

    Cardiogenic shock, defined as decreased myocardial performance and cardiac output leading to end-organ hypoperfusion and hypoxemia, is associated with significant morbidity and mortality. Mechanical circulatory support such as veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is reserved for severe and refractory cases of cardiogenic shock. The use of VA-ECMO has increased significantly in the past decade with increasing indications including acute myocardial infarction, decompensated heart failure, post-cardiotomy syndrome (PCS), cardiac arrest, and refractory cardiopulmonary failure  . While VA-ECMO provides full cardiopulmonary support and rapidly restores systemic perfusion, VA-ECMO is associated with adverse myocardial loading conditions by increasing afterload and worsening myocardial oxygen consumption, which leads to left ventricular distension, pulmonary edema/hemorrhage and impairs myocardial recovery  . One of the strategies to unload the left ventricle is combined VA-ECMO and Impella (Abiomed, Danvers, MA) support, often referred to as “ECPELLA.” Left ventricular (LV) venting, also known as LV unloading, shifts the LV pressure-volume loop down and to the left. This reduces pressure-volume area and thus myocardial workload ( Fig. 1 A ) while also decreasing LV wall tension, as per Laplace's law ( Fig. 1 B). The net effect is a reduction in myocardial oxygen consumption while at the same time improving ventricular and pulmonary congestion.

This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Review our Privacy Policy for more details