Right ventricular injury definition and management in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation: a scoping review

Abstract

Purpose: Right ventricular (RV) injury in patients with respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A consensus on the definition and management of RV injury in patients receiving VV ECMO is currently lacking. Therefore, a scoping review is necessary to map the current literature and guide future research regarding the definition and management of RV injury in patients receiving VV ECMO. Methods: Using a robust scoping review methodology, we searched for relevant publications on RV injury in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Two authors extracted the data independently and in duplicate. Results: Of 1,868 citations screened, 30 studies reporting on RV injury during VV ECMO were identified. Of those, twenty-three studies reported on the definition of RV injury including echocardiographic indices of RV function and dimensions (tricuspid annular plane systolic excursion or right to left ventricular end-diastolic area ratio, respectively). Thirteen studies reported on the management of RV injury, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation, and optimization of positive end-expiratory pressure. Conclusion: The definitions of RV injury in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RV injury during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RV injury are lacking. To fill the existing knowledge gaps, a consensus on the definition of RV injury and research investigating RV-targeted therapies during VV ECMO are urgently warranted. Trial Registration The search protocol was registered in the Open Science Framework (https://osf.io/e2km6).