Veno-pulmonary extracorporeal membrane oxygenation for concomitant right ventricular and respiratory support: A systematic review of utilization patterns and outcomes

Abstract

Background

Veno-pulmonary artery extracorporeal membrane oxygenation (V-P ECMO) is a configuration of extracorporeal life support (ECLS) for patients with isolated or predominantly right ventricular (RV) failure and inadequate gas exchange due to severe respiratory failure. We aimed to systematically review the existing literature to better understand its utilization patterns and associated outcomes.

Methods

The electronic search identified all studies reporting the characteristics and outcomes of V-P ECMO use in adult patients. Patient-level data for 110 patients from 60 case reports and case series were extracted and analyzed.

Results

The median patient age was 45 [IQR, 32–56] years, and 63% were male. Patients most commonly presented with moderate to severe RV dysfunction (90%), along with acute hypoxic respiratory failure (64%) and severe pulmonary hypertension (23%). On presentation, 85% of patients were placed on ventilatory support for a median duration of 13 [5–32] days. V-P ECMO was initiated in the setting of a primary cardiorespiratory pathology in 75% of cases, and major chest surgery in 25% of cases. A percutaneous dual-lumen cannula was used in 64% of cases, of which 29% required an additional cannula. The median duration of V-P ECMO support was 12 [7–31] days. Overall, 42% of patients recovered, 26% underwent lung transplantation, and 9% underwent heart transplantation. In-hospital mortality was 22%. At a median follow-up time of 81 [44–181] days, overall survival was 75%.

Conclusion

V-P ECMO can be utilized in place of traditional ECLS strategies with favorable outcomes across various settings.