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VA-ECMO LV Distension — EECC MCQ

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HardGeneral CardiologyVA-ECMO LV DistensionEECC

A patient in profound post-infarction cardiogenic shock is supported with peripheral VA-ECMO. Pulmonary oedema worsens, the aortic valve rarely opens and the LV becomes progressively distended despite adequate circuit flow. What is the key haemodynamic problem?

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Correct answer: D — Retrograde aortic flow increasing LV afterload and preventing ejection

Peripheral VA-ECMO returns blood retrogradely into the aorta and can markedly increase LV afterload. A failing LV may cease ejecting, causing distension, pulmonary oedema and stasis; active unloading with an Impella, vent, septostomy or selected IABP strategy should be considered.

Reference: https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines