Acute cardiac care & resuscitation
Left Ventricular Decompression in Paediatric Veno-Arterial Extracorporeal Life Support: Reviewing the Evidence
Authors' conclusion
In conclusion, LV decompression during paediatric VA ECLS remains technically challenging and variably adopted. Its benefit appears more consistent in the post-cardiotomy setting, where improved survival and reduced adverse outcomes were observed. Given the lack of standardization, further prospective studies and collaborative registries are essential to guide strategy selection, timing and risk-benefit balance, particularly in such a vulnerable population.
Study context
- Population
- Neonatal and paediatric patients under 18 years of age on VA ECLS undergoing left ventricular (LV) decompressionpaediatric patients undergoing decompression in 11 retrospective cohorts and registry-based studies (2012–2024), also 13 case series (70 patients) and 28 case reports (28 patients) · 11 retrospective cohorts and registry-based studies 1,222 · Thirteen case series 70 · 28 case reports 28
- Participants
- 1,222 participants
- Outcome
- Prevalence of LV decompression
Methodological detailsfollowing PRISMA guidelines
- Following PRISMA guidelines
Pooled result
As reported in the abstract
Post-cardiotomy
46.6%
Non-post-cardiotomy peripheral VA ECLS
10.5%
Further pooled results
VA ECLS configuration and decompression approach
- Supported with peripheral VA ECLS
- 57.1%
- Underwent percutaneous decompression
- 57.4%
- Surgical approaches predominated in post-cardiotomy central VA ECLS
Decompression technique
- Balloon atrial septostomy (BAS)
- 50%
- Surgically placed left atrial cannula
- 37.4%
Safety
Adverse events with PAS-based strategies such as BAS (arrhythmia, bleeding and cardiac perforation)
- Arrhythmia, bleeding and cardiac perforation
- 7%-9% of cases
Impella complications
- Haemolysis
- 50%
- Major bleeding
- 20%
Original publication
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