# Left ventricular unloading with gentle chest compressions for patients on veno-arterial extracorporeal membrane oxygenation: two case reports

## TL;DR

Gentle chest compressions helped improve heart function in two patients on VA-ECMO, preventing dangerous blood clots without causing harm.

## Contribution

Gentle chest compressions are introduced as a novel, safe method to address left ventricular unloading in VA-ECMO patients.

## Key findings

- Gentle chest compressions effectively drained the left ventricle in VA-ECMO patients.
- The method prevented intracardiac thrombi formation without causing complications.
- This approach is safe and could be a new treatment option for VA-ECMO patients.

## Abstract

Insufficient ventricular unloading is a serious complication during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) that has a crucial impact on patient outcomes. The existing conservative treatment options are limited, while mechanical decompression techniques are challenging and restricted in terms of their adoption and application. Two patients with cardiogenic shock experienced insufficient left ventricular unloading with no pulsatile contraction and aortic valve closure during VA-ECMO support. Gentle chest compression was applied to establish an active left ventricular drainage mechanism, which prevented the formation of intracardiac thrombi. No life-threatening complications or technical problems occurred. Therefore, gentle chest compression was established as an effective and safe method for treating insufficient left ventricular unloading in VA-ECMO patients.