A New Option for Saving Lives 

    Cardiogenic shock refers to a sudden decline in heart function that leaves the heart unable to effectively pump blood, leading to a critical state where the body’s vital organs are not getting enough blood. For patients and their families, this condition strikes with alarming suddenness and danger, and traditional treatments (for example, heart-strengthening medications or an intra-aortic balloon pump) often struggle to turn the tide. 

        In recent years, extracorporeal membrane oxygenation (ECMO) has become one of the crucial tools for saving such critical patients. However, conventional veno-arterial ECMO (VA ECMO) — while taking over the function of the heart and lungs — can increase the burden on the left ventricle due to the strong blood flow it delivers, potentially leading to complications like pulmonary edema (fluid in the lungs). To address this problem, a new technique called LAVA ECMO emerged, bringing fresh hope to patients caught in cardiogenic shock. 

What is LAVA ECMO? 

        LAVA ECMO builds on traditional VA ECMO by adding an extra drainage tube that is inserted directly into the left atrium (LA) of the heart. Through a minimally invasive procedure, blood can be drawn simultaneously from both the right atrium and the left atrium, then fully oxygenated by the ECMO machine before being returned to the arteries. This is like adding a safety valve to the ECMO system to divert pressure from the left side of the heart, dramatically reducing the strain on that side. Because this method relieves the left heart without requiring open-chest surgery, it also lowers the risk of complications such as infection and bleeding. For patients, LAVA ECMO gives a desperately failing heart room to breathe and recover — essentially holding up a protective umbrella for the heart in the middle of the storm. 

International Research Evidence 

        Research from South Korea has indicated that performing left atrial decompression at the same time as VA ECMO support can greatly reduce early mortality in patients. Experience in the United States has also found that after using LAVA ECMO, patients’ cardiac pressure improves significantly in a short time, the 30-day survival rate exceeds 50%, and complications occur less frequently. According to current international data, timely relief of pressure on the left side of the heart helps improve a patient’s condition and increases the chances of survival for those in critical care. 

       Facing cardiogenic shock, medical teams have several mechanical support devices to choose from: 

·         IABP (Intra-Aortic Balloon Pump): The procedure is relatively simple, but its effect on reducing the left heart’s workload is limited. It is more suitable for patients who are not in the most severe condition. 

·         Traditional VA ECMO: Provides strong circulatory support, but also increases left ventricular pressure, meaning additional measures are needed to relieve that pressure. 

·         VAD (Ventricular Assist Device): Comes in surgical and minimally invasive forms (such as the Impella device). It can effectively unload the left ventricle’s pressure, but is extremely expensive.

        In comparison, LAVA ECMO combines robust circulatory support with effective left-heart pressure relief, all without requiring open-chest surgery. This makes it especially suitable for patients in acute cardiac crisis. 

Far Eastern Memorial Hospital’s Clinical Results 

       Far Eastern Memorial Hospital (FEMH) is one of the earliest medical centers in Taiwan to introduce LAVA ECMO. We formed a dedicated cross-disciplinary team, with core members from the Emergency Department, Cardiovascular Medicine, and Cardiovascular Surgery working closely together. The team developed standardized procedures, and experts are on call 24 hours a day — ready at any time to perform left atrial decompression when needed. Over the years, we have accumulated a wealth of clinical cases and have shared our team’s experience at international medical conferences multiple times. 

      As of the end of 2024, our hospital has successfully performed LAVA ECMO on over 80 patients, and overall treatment outcomes have improved significantly. The 30-day survival rate of these patients is nearly 50%, far higher than what is seen with traditional treatments. Especially for patients whose shock was triggered by an acute myocardial infarction, using LAVA ECMO led to a notable recovery of severely impaired heart function, showing that this technique truly helps the heart overcome a crisis. For patients who developed pulmonary edema due to heart failure, LAVA ECMO was like rain after a long drought. In most of these cases, once the left atrial drainage tube was placed, the fluid buildup in the lungs quickly subsided and the patients’ breathing improved. 

A Second Chance at Life 

       We have had several end-stage heart failure patients who, supported by LAVA ECMO, successfully held on until a donor heart became available — they underwent heart transplant and gained a new life. These cases demonstrate that LAVA ECMO can not only stabilize a patient’s life in critical moments, but also give those in need enough time to receive the next stage of treatment. 

FEMH’s LAVA ECMO team has worked hard to innovate and has achieved outstanding results, earning recognition with the National Healthcare Quality Award (NHQA) Gold Award for Outstanding Medical Care in 2024. This honor symbolizes our determination to safeguard life, and it belongs to every patient and healthcare provider who has battled against illness. 

       Finally, for patients and their families, every moment spent waiting for recovery feels interminable. The advent of LAVA ECMO has brought a turning point in this race against time. From Far Eastern Memorial Hospital’s proven results to supportive findings from international research, we firmly believe this technology can create a turnaround for more lives. In the future, we will continue to refine our techniques, hoping to make LAVA ECMO the guardian of even more families — holding up an umbrella of hope in their darkest hours. 

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