CTICasesVA-ECMO with Axillary Impella LV Venting
Imaging findings
Chest radiograph shows a venoarterial extracorporeal membrane oxygenation (VA-ECMO) venous cannula in the right atrium and an axillary-placed Impella left ventricular (LV) assist device. There is severe cardiomegaly and alveolar pulmonary edema due to LV volume overload.
Key takeaways
VA-ECMO provides excellent circulatory support but increases left ventricular afterload by pumping blood retrograde into the aorta. In patients with poor myocardial contractility, this can cause left ventricular over-distension, stasis, and severe pulmonary edema. Placing an Impella device serves to vent (decompress) the left ventricle, improving pulmonary congestion and reducing myocardial work.
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