Unloading the Left Ventricle in Venoarterial ECMO: In Whom, When, and How?

Saad M. Ezad, Matthew Ryan, Dirk W. Donker, Federico Pappalardo, Nicholas Barrett, Luigi Camporota, Susanna Price, Navin K. Kapur, Divaka Perera*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

9 Citations (Scopus)
56 Downloads (Pure)


Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.

Original languageEnglish
Pages (from-to)1237-1250
Number of pages14
Issue number16
Early online date17 Apr 2023
Publication statusPublished - 18 Apr 2023


  • extracorporeal membrane oxygenation
  • heart failure
  • heart-assist devices
  • hemodynamics
  • myocardial infarction
  • shock
  • shock, cardiogenic
  • 2023 OA procedure


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