LAVA-ECMO has recently gained attention in the medical community, specifically, as support for cardiogenic-shock patients. In particular, interest has picked up since it was highlighted at the 2023 Houston Shock Symposium.

LAVA-ECMO refers to the use of left atrial venoarterial cannulation during extracorporeal membrane oxygenation. That is, left atrial VA-ECMO. Patients with severe cardiogenic shock need mechanical-respiratory and hemodynamic support with VA ECMO. However, this treatment can increase the mechanical load on the left ventricle which may worsen pulmonary edema and make cardiac recovery more challenging.

Unloading the left ventricle (LV) during VA-ECMO can mitigate some of these risks. Typically, this is done with temporary mechanical circulatory support like an intra-aortic balloon pump or a percutaneous left ventricular assist device.  

LAVA-ECMO, on the other hand, “involves placement of a left-atrial drainage catheter that is placed via interatrial transseptal puncture. This would allow for direct left atrial drainage, thereby reducing pulmonary capillary wedge pressure and left ventricular preload thereby unloading the LV.”[1] 

LAVA-ECMO in Action

Several doctors highlighted the benefits of this strategy during the 2023 Houston Shock Symposium.

As reported by docwirenews, Dr. William W. O’Neill spoke about using LAVA-ECMO as a bridge to definitive repair for a patient in cardiogenic shock, and Dr. Jeffrey Wang used LAVA-ECMO for a patient with refractory cardiogenic shock who had developed a worsening pulmonary edema.  

The LAVA-ECMO technique was also highlighted a year earlier at the 2022 Technology and Heart Failure Therapeutics (THT) meeting, where Dr. Waleed Al-Darzi spoke about the advantages of LAVA-ECMO. He presented on the outcomes of 25 patients who were treated at his center.

“What it does is it unloads, or vents, both sides—the right and left side—of the heart at the same time with a single cannula, rather than requiring an additional large-bore arterial access on top of the regular VA ECMO configuration,” he told TCTMD, a publication produced by the Cardiovascular Research Foundation.[2]  

“It’s a great tool in experienced hands.”