Introduction: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid cardiac recovery and prevent complications of increased afterload. However, there is no consensus on when and which unloading strategy should be used.
Methods: An online survey was distributed worldwide via the EuroELSO newsletter mailing list to describe contemporary international practice and evaluate heterogeneity in strategies for LV unloading.
Results: Of 192 respondents from 43 countries, 53% routinely use mechanical LV unloading, to promote ventricular recovery and/or to prevent complications. Of those that do not routinely unload, 65% cited risk of complications as the reason. The most common indications for unplanned unloading were reduced arterial line pulsatility (68%), pulmonary edema (64%) and LV dilatation (50%). An intra-aortic balloon pump was the most frequently used device for unloading followed by percutaneous left ventricular assist devices. Echocardiography was the most frequently used method to monitor the response to unloading.
Conclusions: Significant variation exists with respect to international practice of ventricular unloading. Further research is required that compares the efficacy of different unloading strategies and a randomized comparison of routine mechanical unloading versus unplanned unloading.
Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Donker reports speaker fees from Getinge-Maquet and Fresenius-Xenios-NovaLung and research cooperation with Getinge-Maquet and FreseniusXenios-NovaLung. Dr Pappalardo reports personal fees from Abiomed unrelated to the submitted work. Dr Kapur has received institutional research support and speaker/consulting honoraria from Abbott, Abiomed, Boston Scientific, Getinge, LivaNova, Medtronic, MDStart, Precardia, and Zoll. Prof. Perera reports receiving speaker fees/honoraria/research grant support from Abiomed, Getinge, Abbott Vascular and Philips.