Proposal for a trial of early left ventricular venting during venoarterial extracorporeal membrane oxygenation for cardiogenic shockCentral MessagePerspective
Michael Ibrahim, MD, PhD,
Michael A. Acker, MD,
Wilson Szeto, MD,
Jacob Gutsche, MD,
Matthew Williams, MD,
Pavan Atluri, MD,
Matthew Woods, MD,
Thomas Richards, PhD,
Timothy J. Gardner, MD,
Jeremy McGarvey, MD,
Mark Epler, MD,
Joyce Wald, MD,
Eduardo Rame, MD,
Edo Birati, MD,
Christian Bermudez, MD
Affiliations
Michael Ibrahim, MD, PhD
Address for reprints: Michael Ibrahim, MD, PhD, Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA 19104.; Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Michael A. Acker, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Wilson Szeto, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Jacob Gutsche, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Matthew Williams, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Pavan Atluri, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Matthew Woods, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Thomas Richards, PhD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Timothy J. Gardner, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Jeremy McGarvey, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Mark Epler, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Joyce Wald, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Eduardo Rame, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Edo Birati, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Christian Bermudez, MD
Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, The University of Pennsylvania, Philadelphia, Pa
Objective: Patients with profound cardiogenic shock may require venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for circulatory support most commonly via the femoral vessels. The rate of cardiac recovery in this population remains low, possibly because peripheral VA-ECMO increases ventricular afterload. Whether direct ventricular unloading in peripheral VA-ECMO enhances cardiac recovery is unknown, but is being more frequently utilized. A randomized trial is warranted to evaluate the clinical effectiveness of percutaneous left ventricle venting to enhance cardiac recovery in the setting of VA-ECMO. Methods: We describe the rationale, design, and initial testing of a randomized controlled trial of VA-ECMO with and without percutaneous left ventricle venting using a percutaneous micro-axial ventricular assist device. Results: This is an ongoing prospective randomized controlled trial in adult patients with primary cardiac failure presenting in cardiogenic shock requiring peripheral VA-ECMO, designed to test the safety and effectiveness of percutaneous left ventricle venting in improving the rate of cardiac recovery. Conclusions: The results of this nonindustry-sponsored trial will provide critical information on whether left ventricle unloading in peripheral VA-ECMO is safe and effective.
