Acute cardiopulmonary failure in a young woman with high-risk gestational trophoblastic neoplasia: A case of induction chemotherapy during extracorporeal membrane oxygenation

Management of high-risk elderly patients requiring revascularisation remains a clinical challenge. We report a case of extracorporeal membrane oxygenation (ECMO) assisted complex percutaneous coronary intervention in a high-risk octogenarian. An 83-yearold female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. Transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. Three-vessel disease was found during coronary angiography. Due to the patient’s frailty, a high-risk surgery decision to proceed with ECMO assisted percutaneous coronary intervention was made during a heart team meeting. Following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. After the procedure, the patient was transferred to the ICU on ECMO support, where she was successfully weaned from the device 9 h later. Her ICU stay was four days. She was successfully discharged from the hospital after uneventful recovery. At one-year’s follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. This report highlights the possibility of use of ECMO during PCI in high-risk elderly patients.

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An innovative ovine model of severe cardiopulmonary failure supported by veno-arterial extracorporeal membrane oxygenation

Scientific Reports ◽

10.1038/s41598-021-00087-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Silver Heinsar ◽

Jae-Seung Jung ◽

Sebastiano Maria Colombo ◽

Sacha Rozencwajg ◽

Karin Wildi ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Troponin I ◽

Cardiac Injury ◽

Ventilatory Support ◽

Left Ventricular ◽

Ovine Model ◽

Membrane Oxygenation ◽

Cardiopulmonary Failure ◽

Va Ecmo ◽

Inflammatory Infiltrates

AbstractRefractory cardiogenic shock (CS) often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Current animal models result in heterogenous cardiac injury and frequent episodes of refractory ventricular fibrillation. Thus, we aimed to develop an innovative, clinically relevant, and titratable model of severe cardiopulmonary failure. Six sheep (60 ± 6 kg) were anaesthetized and mechanically ventilated. VA-ECMO was commenced and CS was induced through intramyocardial injections of ethanol. Then, hypoxemic/hypercapnic pulmonary failure was achieved, through substantial decrease in ventilatory support. Echocardiography was used to compute left ventricular fractional area change (LVFAC) and cardiac Troponin I (cTnI) was quantified. After 5 h, the animals were euthanised and the heart was retrieved for histological evaluations. Ethanol (58 ± 23 mL) successfully induced CS in all animals. cTnI levels increased near 5000-fold. CS was confirmed by a drop in systolic blood pressure to 67 ± 14 mmHg, while lactate increased to 4.7 ± 0.9 mmol/L and LVFAC decreased to 16 ± 7%. Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. In conclusion, we present an innovative ovine model of severe cardiopulmonary failure in animals on VA-ECMO. This model could be essential to further characterize CS and develop future treatments.

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TCT-320 Prophylactic Veno-Arterial–Extracorporeal Membrane Oxygenation in Patients Undergoing High-Risk Percutaneous Coronary Interventions

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.399 ◽

2019 ◽

Vol 74 (13) ◽

pp. B318

Author(s):

Floris van den Brink ◽

Tom Meijers ◽

Krischan Sjauw ◽

Sjoerd H. Hofma ◽

Alexander Nap ◽

...

Keyword(s):

High Risk ◽

Extracorporeal Membrane Oxygenation ◽

Percutaneous Coronary Interventions ◽

Membrane Oxygenation ◽

Coronary Interventions ◽

Percutaneous Coronary

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1077. Reduce Anti-Microbial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.941 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S382-S382

Author(s):

Aditya Shah ◽

Prabij Dhungana ◽

Kirtivardhan Vashistha ◽

Priya Sampathkumar ◽

John Bohman ◽

...

Keyword(s):

Infectious Disease ◽

High Risk ◽

Extracorporeal Membrane Oxygenation ◽

Life Support ◽

Task Force ◽

Antimicrobial Prophylaxis ◽

Extracorporeal Life Support ◽

Antimicrobial Use ◽

Membrane Oxygenation ◽

Critically Ill Adults

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. Patients on ECMO are at high risk for infections, with 20.5% of adults acquiring infections while on ECMO. An Extracorporeal Life Support Organization (ELSO) Infectious Disease Task Force statement concluded that no antibiotic prophylaxis is needed for patients on ECMO though it also noted that this was based on limited data. We implemented an antimicrobial prophylaxis protocol for patients on ECMO at our institution and analyzed antimicrobial use and outcomes in these patients with a pre- and post-analysis. Methods We conducted a retrospective review of 294 patients on ECMO between July 1, 2011 and July 1, 2017. An ECMO antimicrobial prophylaxis guideline was initially implemented on July 1, 2014; there was poor adherence to the guideline and antimicrobial use actually increased. A more restrictive protocol was implemented in November 2018 with input from stakeholders including cardiac surgeons, critical care and infectious disease (ID) providers. We had a cohort of 161 patients before (July 2014–November 2018) and 37 patients after (November 2018–April 2018) the implementation of the updated protocol. We evaluated primary outcomes of gross days of antimicrobial use, percent of antibiotic-free days and days of individual antimicrobial use, adjusted for APACHE scores and ECMO duration. Results When adjusted for days on ECMO, mean antibiotic days decreased after implementation of the protocol; for vancomycin (0.27 vs. 0.02, P < 0.0003), cefepime (0.15 vs. 0.02, P < 0.02), meropenem (0.09 vs. 0, P < 0.02), zosyn (0.16 vs. 0, P < 0.002), caspofungin (0.346, 0.138 P < 0.003). This was accompanied by a nonsignificant increase in mean fluconazole use (0.29 vs. 0.37, P < 0.3). There was no impact on patient mortality or nosocomial infection rate. Additional results can be found in table. Conclusion The use of an antimicrobial prophylaxis protocol in ECMO patients led to improvement in antimicrobial usage without increasing nosocomial infections in a population at a high risk of infection. Disclosures All authors: No reported disclosures.

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