Cardiac dimensions during extracorporeal membrane oxygenation

2005 ◽  
Vol 15 (4) ◽  
pp. 373-378 ◽  
Author(s):  
Ronald B. Tanke ◽  
Otto Daniëls ◽  
Arno F. van Heijst ◽  
Henk van Lier ◽  
Cees Festen
Keyword(s):  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Loading Conditions ◽  
Volume Loading ◽  
Membrane Oxygenation ◽  
Arterial Duct ◽  
Before And After ◽  
Fractional Shortening

Our aim was to analyze left ventricular fractional shortening during extracorporeal membrane oxygenation under the influence of changing volume loading conditions induced by a ductal left-to-right shunt. In all patients, the fractional shortening was observed using echocardiography before, during, and after bypass, irrespective of the presence or absence of the ductal left-to-right shunt. During membrane oxygenation, there was a significant decrease in fractional shortening (p less than 0.001), with no difference before and after membrane oxygenation. A greater decrease in fractional shortening was observed in the group with a ductal left-to-right shunt when compared to patients lacking the ductal shunt (p less than 0.006). The diastolic diameter of the left ventricle also increased significantly during the membrane oxygenation in those patients with left-to-right ductal shunting. Moreover, the patients with left-to-right shunting showed a very severe decreased fractional shortening, lower than 10 per cent, with significantly greater frequency (p less than 0.05) during the course of membrane oxygenation. Conclusion: An important decrease in left ventricular fractional shortening is observed during veno-arterial extracorporeal membrane oxygenation. Left-to-right shunting during bypass, as seen in the patients with patency of the arterial duct, increases the loading conditions on the left ventricle, and produces a significant increase in left ventricular diastolic dimensions. Despite the effects of volume loading produced by the ductal shunt during bypass, the decrease in fractional shortening is significantly more pronounced for these patients. Therefore, during membrane oxygenation the volume loading produced by the ductal shunt is unable to prevent a decrease in left ventricular fractional shortening.

In vivo determination of left ventricular wall stress-shortening relationship in normal mice

1997 ◽  
Vol 272 (2) ◽  
pp. H1047-H1052 ◽  
Author(s):  
B. D. Hoit ◽  
Z. U. Khan ◽  
C. M. Pawloski-Dahm ◽  
R. A. Walsh
Keyword(s):  
Mouse Genome ◽  
Phenotypic Expression ◽  
Wall Stress ◽  
Left Ventricular ◽  
Loading Conditions ◽  
Inotropic State ◽  
Before And After ◽  
Fractional Shortening

Although targeted alterations of the mouse genome are used increasingly to identify the mechanisms underlying cardiac function, the methods used to study the phenotypic expression of these alterations in vivo are limited. To derive a relatively noninvasive, load-independent measure of left ventricular (LV) contractility in mice, we cannulated the femoral artery and performed two-dimensional directed M-mode echo studies in 28 anesthetized FVB/N mice, using a 9-MHz transducer. Loading conditions were altered by intraarterial methoxamine (3-12 microg/g), and LV shortening fraction was determined at several steady states, both before and after myocardial contractility was altered by either 4 microg/g intraperitoneal dobutamine (n = 16) or 1-2 microg/g verapamil (n = 12). The relation between LV systolic meridional stress and fractional shortening derived from pooled baseline data was inverse and linear [r = 0.80, slope = -0.19, intercept = 48%, standard error of estimate (SEE) = 5.5%, P < 0.001]. Dobutamine produced a parallel upward shift of the relation (r = 0.87, slope = -0.21, intercept = 61%, SEE = 4.5%, P < 0.001), and verapamil produced a downward shift of the relation (r = 0.48, slope = -0.05, intercept = 24%, SEE = 3.7%, P < 0.05). At matched levels of end-systolic stress, dobutamine increased and verapamil decreased the LV shortening fraction. We conclude that 1) inverse stress-shortening relations can be assessed noninvasively in mice; and 2) these relations are sensitive to alterations in inotropic state, independent of loading conditions.

A 24-hour perioperative case study on argatroban use for left ventricle assist device insertion during cardiopulmonary bypass and veno-arterial extracorporeal membrane oxygenation

Perfusion ◽  
2018 ◽  
Vol 34 (4) ◽  
pp. 337-344 ◽  
Author(s):  
Philip Fernandes ◽  
Michael O’Neil ◽  
Samantha Del Valle ◽  
Anita Cave ◽  
Dave Nagpal
Keyword(s):  
Cardiopulmonary Bypass ◽  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Clot Formation ◽  
Left Ventricular Ejection ◽  
Assist Device ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Ventricle Assist Device

A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation. Following a positive heparin-induced thrombocytopenia (HIT) assay, a total circuit exchange was required to eliminate all heparin coating and argatroban was deemed the anticoagulant of choice due to acute kidney injury. On POD#24, the decision was made to implant a left ventricle assist device (LVAD) as a bridge to heart transplantation. There was difficulty achieving an activated clotting time (ACT) >400 s: multiple argatroban bolus doses were required, along with accelerated up-titration of infusion dosing. Despite maintaining an ACT >484 s, clot formation was observed in the cardiotomy reservoir prior to separation. Subsequently, the patient developed severe disseminated intravascular coagulopathy, with both intra-cardiac and intravascular thrombi, requiring massive transfusion and continuous cell saving due to severe hemorrhage post cardiopulmonary bypass (CPB). The patient received a total of 105 units of plasma, 74 units of packed red cells, 19 units of platelets, 13 bottles of 5% albumin, 6 units of cryoprecipitate and 2 doses of factor VIIa intraoperatively over the course of 24 hours. A total of 19.7 L of washed red blood cells were returned to the patient from the cell saver. With the LVAD in place, the patient developed transfusion-related acute lung injury and acute respiratory distress syndrome with right ventricular dysfunction requiring VA ECMO once again. On POD#30, ECMO was discontinued and the patient was discharged from the intensive care unit (ICU) on POD 66. After a very complex post-operative stay with numerous surgeries and extensive rehabilitation, the patient was discharged home with the LVAD on POD#112.

scholarly journals RELATION BETWEEN LEFT VENTRICULAR UNLOADING DURING ECMO AND DRAINAGE CATHETER SIZE ASSESSED BY MATHEMATICAL MODELING

2017 ◽  
Vol 57 (5) ◽  
pp. 367 ◽  
Author(s):  
Svitlana Strunina ◽  
Jiri Hozman ◽  
Petr Ostadal
Keyword(s):  
Blood Flow ◽  
Left Ventricle ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Computational Method ◽  
Extracorporeal Blood ◽  
Membrane Oxygenation ◽  
Drainage Catheter ◽  
Catheter Size ◽  
The Impact

The flow-dependent left ventricle overload is a well-known complication of the veno-arterial extracorporeal membrane oxygenation in a severe cardiogenic shock, which leads to a distension of the left ventricle and, frequently, to a severe pulmonary edema. Recently, an unloading of the left ventricle using a catheter inserted to the left ventricle and connected to the extracorporeal membrane oxygenation circuit has been proposed. The computational method was used to simulate the blood flow in the extracorporeal membrane oxygenation system with a drainage catheter incorporated to the left ventricle and connected to the inflow part of the extracorporeal membrane oxygenation circuit by a Y-shaped connector. The whole system was modelled in Modelica modelling language. The impact of various catheter sizes (from 5 Fr to 10 Fr) and extracorporeal blood flow values (from 1L/min to 5 L/min) were investigated. In our simulation model, the extracorporeal blood flow only modestly affected the value of volume that was withdrawn from the left ventricle by a catheter. Conversely, the size of the drainage catheter was the principal factor responsible for the achievement of the adequate left ventricle decompression. A 10 Fr drainage catheter, inserted into the left ventricle and connected to the venous part of the ECMO system, presents a promising solution to the unloading of the left ventricle during a extracorporeal membrane oxygenation.

scholarly journals Influence of extracorporeal membrane oxygenation on serum microRNA expression

2019 ◽  
Vol 47 (12) ◽  
pp. 6109-6119
Author(s):  
M. Scettri ◽  
H. Seeba ◽  
D. L. Staudacher ◽  
S. Robinson ◽  
D. Stallmann ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real Time ◽  
Underlying Disease ◽  
Real Time Quantitative Pcr ◽  
Membrane Oxygenation ◽  
Serum Microrna ◽  
Clinical Biomarkers ◽  
Differentially Expressed Mirnas ◽  
Before And After ◽  
Medical Intensive Care

Objective To date, no biomarkers have been established to predict haematological complications and outcomes of extracorporeal membrane oxygenation (ECMO). The aim of this study was to investigate the expression of a panel of microRNAs (miRNAs), which are promising biomarkers in many clinical fields, in patients before and after initiating ECMO. Methods Serum miRNA levels from 14 patients hospitalized for acute respiratory failure and supported with ECMO in our medical intensive care unit were analysed before and 24 hours after ECMO. In total, 179 serum-enriched miRNAs were profiled by using a real-time PCR panel. For validation, differentially expressed miRNAs were individually quantified with conventional real-time quantitative PCR at 0, 24, and 72 hours. Results Under ECMO support, platelet count significantly decreased by 65 × 103/µL (25th percentile = 154.3 × 103/µL; 75th percentile = 33 × 103/µL). Expression of the 179 miRNAs investigated in this study did not change significantly throughout the observational period. Conclusions According to our data, the expression of serum miRNAs was not altered by ECMO therapy itself. We conclude that ECMO does not limit the application of miRNAs as specific clinical biomarkers for the patients’ underlying disease.

Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock

Perfusion ◽  
2021 ◽  
pp. 026765912110339
Author(s):  
Shek-yin Au ◽  
Ka-man Fong ◽  
Chun-Fung Sunny Tsang ◽  
Ka-Chun Alan Chan ◽  
Chi Yuen Wong ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Queen Elizabeth Hospital ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Va Ecmo

Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

scholarly journals Successful extracorporeal membrane oxygenation resuscitation of patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism: A case report

2021 ◽  
Vol 16 (1) ◽  
pp. 746-751
Author(s):  
Tao Wang ◽  
Qiancheng Xu ◽  
Xiaogan Jiang
Keyword(s):  
Case Report ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Tumour Size ◽  
Acute Onset ◽  
Left Ventricular ◽  
Vanillylmandelic Acid ◽  
Membrane Oxygenation ◽  
First Case ◽  
Va Ecmo

Abstract A 29-year-old woman presented to the emergency department with the acute onset of palpitations, shortness of breath, and haemoptysis. She reported having an abortion (56 days of pregnancy) 1 week before admission because of hyperthyroidism diagnosis during pregnancy. The first diagnoses considered were cardiomyopathy associated with hyperthyroidism, acute left ventricular failure, and hyperthyroidism crisis. The young woman’s cardiocirculatory system collapsed within several hours. Hence, venoarterial extracorporeal membrane oxygenation (VA ECMO) was performed for this patient. Over the next 3 days after ECMO was established, repeat transthoracic echocardiography showed gradual improvements in biventricular function, and later the patient recovered almost completely. The patient’s blood pressure increased to 230/130 mm Hg when the ECMO catheter was removed, and then the diagnosis of phaeochromocytoma was suspected. Computed tomography showed a left suprarenal tumour. The tumour size was 5.8 cm × 5.7 cm with central necrosis. The vanillylmandelic acid concentration was 63.15 mg/24 h. Post-operation, pathology confirmed phaeochromocytoma. To our knowledge, this is the first case report of a patient with cardiogenic shock induced by phaeochromocytoma crisis mimicking hyperthyroidism which was successfully resuscitated by VA ECMO.

Radiographic appearance of extracorporeal membrane oxygenations versus left ventricular assist device

2021 ◽  
Vol 31 (5) ◽  
pp. 831-832
Author(s):  
Phillip M Mackie ◽  
Giles J Peek ◽  
Jeffrey P Jacobs ◽  
Mark S Bleiweis
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Chest Radiography ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Radiographic Appearance ◽  
Membrane Oxygenation ◽  
Left Ventricular Assist

AbstractChest radiography compares left ventricular decompression in the same patient supported with extracorporeal membrane oxygenation with atrial septal fenestration and subsequently supported with left ventricular assist device with apical cannulation.

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