• Chiara Lazzeri, Manuela Bonizzoli, Giovanni Cianchi, Stefano Batacchi, Marco Chiostri, Giorgio Fulceri, and Adriano Peris.
• Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: lazzeric@libero.it.
• J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1441-1445.

ObjectiveIn severe acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO), right ventricular (RV failure) and dilation have been investigated with the use of echocardiography, whereas RV hypertrophy has not been addressed in the literature. The present study assessed the incidence of RV hypertrophy using echocardiography before ECMO treatment and at intensive care unit (ICU) discharge in severe ARDS patients.DesignObservational, retrospective, single-center study.SettingA single ECMO center.ParticipantsThe study comprised 46 consecutive patients with severe ARDS.InterventionEchocardiographic evaluation and ECMO support.Measurements And Main ResultsA dual-lumen cannula was implanted in most patients (38/46 [82.6%]). Before the start of ECMO, RV hypertrophy was present in 28 patients (60.8%) with no significant differences in baseline characteristics between the 2 subgroups. The ICU mortality rate was 30.4% (14/46), with no difference between patients with RV hypertrophy and those without. At ICU discharge, all patients showed RV hypertrophy.ConclusionsIn severe ARDS treated with ECMO support, RV hypertrophy is a common finding and patients with normal RV wall thickness developed RV hypertrophy after ECMO support. The latter finding may suggest that during ECMO support, the right ventricle still may be subjected to increased afterload. However, additional research should be performed to elucidate the spectrum of mechanism(s) involved in the genesis of RV hypertrophy.Copyright © 2019 Elsevier Inc. All rights reserved.

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