Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used in patients with severe cardiogenic shock refractory to medical therapy. During V-A ECMO, retrograde flow in the aorta towards the left ventricle (LV) causes increased left-sided filling pressures, which may lead to pulmonary edema. Different strategies have been proposed to decompress the left heart, including placement of an intraaortic balloon pump (IABP), Impella® (Abiomed), or TandemHeart® (Cardiac Assist). Percutaneous decompression of the left atrium via placement of a transseptal cannula incorporated into the existing venous limb had also been previously done. We describe the novel use of the VFEM venous femoral cannula (Edwards Lifesciences) placed transseptally in a left atrial, veno-arterial (LAVA) configuration to provide simultaneous bi-atrial drainage in a patient on V-A ECMO due to cardiogenic shock.
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Dulnuan, Kenneth R.; Zwischenberger, Joseph B.; Gurley, John G.; and Guglin, Maya
"Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (LAVA-ECMO): Percutaneous Bi-Atrial Drainage to Avoid Pulmonary Edema in a Patient with Left Ventricular Systolic Dysfunction,"
The VAD Journal: Vol. 8(1)
Available at: https://digitalcommons.library.tmc.edu/vad/vol8/iss1/11