Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation

Jeroen J H Bunge; Kadir Caliskan; Diederik Gommers; Dinis Reis Miranda

doi:10.21037/jtd.2017.10.75

Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation

J Thorac Dis. 2018 Mar;10(Suppl 5):S674-S682. doi: 10.21037/jtd.2017.10.75.

Authors

Jeroen J H Bunge¹, Kadir Caliskan², Diederik Gommers¹, Dinis Reis Miranda¹

Affiliations

¹ Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
² Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

Abstract

Severe ARDS can be complicated by right ventricular (RV) failure. The etiology of RV failure in ARDS is multifactorial. Vascular alterations, hypoxia, hypercapnia and effects of mechanical ventilation may play a role. Echocardiography has an important role in diagnosing RV failure in ARDS patients. Once extracorporeal membrane oxygenation (ECMO) is indicated in these patients, the right ECMO modus needs to be chosen. In this review, the etiology, diagnosis and management of RV failure in ARDS will be briefly outlined. The beneficial effect of veno-venous (VV) ECMO on RV function in these patients will be illustrated. Based on this, we will give recommendations regarding choice of ECMO modus and provide an algorithm for management of RV failure in VV ECMO supported patients.

Keywords: Acute respiratory distress syndrome (ARDS); cor pulmonale; extracorporeal membrane oxygenation (ECMO); heart failure; human; right sided; veno-venous extracorporeal membrane oxygenation (VV ECMO).

Publication types

Review