Right ventricular injury during VV-ECMO for severe ARDS: Does time matter?

Right ventricular injury (RVI) is a frequent complication during veno-venous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. In this single-centre retrospective cohort of 40 patients, RVI was observed in 63%, being associated with increased ICU mortality. RVI at admission was more common in younger patients and those with shorter intubation periods pre-cannulation. RVI developing during VV-ECMO was associated with longer ECMO support, ICU stay, and a trend towards higher mortality. The timing of RVI likely reflects different pathophysiology, having different clinical implications. Improved monitoring of right ventricular function during VV-ECMO may enable earlier detection and intervention, potentially improving outcomes.