scholarly journals Retrieval of Patients in Severe Cardiogenic Shock with Mobile Extracorporeal Life Support (ECLS) Implantation and Subsequent Air- or Ground-Based Transport

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
S.P.W. Guenther ◽  
S. Buchholz ◽  
F. Born ◽  
S. Brunner ◽  
R. Schramm ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Severe Cardiogenic Shock

Single arterial access ECMELLA: A new concept and step-by-step procedure

2021 ◽  
Keyword(s):  
Cardiogenic Shock ◽  
New Technologies ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Ventricular Assist ◽  
Arterial Access ◽  
Severe Cardiogenic Shock ◽  
Step Procedure

Therapy for cardiogenic shock using temporary mechanical circulatory support has improved significantly in the last decades, providing patients with new technologies for both acute phase stabilization and bridging to long-term therapies. A combination of a venoarterial extracorporeal life support system and the Impella left ventricular assist device (known as the ECMELLA approach) represents an effective therapy for severe cardiogenic shock that achieves high-flow circulatory support with simultaneous left-ventricular unloading. We present the new ECMELLA 2.0 concept, whereby a single arterial access technique is used to treat severe cardiogenic shock. The goal of this technique is to reduce access-related complications and make a bedside staged weaning from mechanical support possible.

scholarly journals Extracorporeal life support with left ventricular decompression—improved survival in severe cardiogenic shock: results from a retrospective study

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3813 ◽  
Author(s):  
Bastian Schmack ◽  
Philipp Seppelt ◽  
Alexander Weymann ◽  
Christina Alt ◽  
Mina Farag ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Time Window ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Critically Ill Patient ◽  
Single Centre ◽  
Term Survival ◽  
Bridge To Transplant ◽  
Severe Cardiogenic Shock

ObjectiveExtracorporeal life support (ECLS) is a life-saving procedure used in the treatment of severe cardiogenic shock. Within this retrospective single centre study, we examined our experience in this critically ill patient cohort to assess outcomes and clinical parameters by comparison of ECLS with or without selective left ventricular decompression.MethodsBetween 2004 and 2014 we evaluated 48 adult patients with INTERMACS level 1 heart failure (age 49.7 ± 19.5 years), who received either central ECLS with (n = 20, 41.7%) or ECLS without (n = 28, 58.3%, including 10 peripheral ECLS) integrated left ventricular vent in our retrospective single centre trial.ResultsFollow up was 100% with a mean of 0.83 ± 1.85 years. Bridge to ventricular assist device was feasible in 29.2% (n = 14), bridge to transplant in 10.4% (n = 5) and bridge to recovery in 8.3% (n = 4). Overall 30-day survival was 37.5%, 6-month survival 27.1% and 1-year survival 25.0%. ECLS support with left ventricular decompression showed favourable 30-day survival compared to ECLS without left ventricular decompression (p = 0.034). Thirty-day as well as long-term survival did not differ between the subgroups (central ECLS with vent, ECLS without vent and peripheral ECLS without vent). Multivariate logistic regression adjusted for age and gender revealed ECLS without vent as independent factor influencing 30-day survival.ConclusionECLS is an established therapy for patients in severe cardiogenic shock. Independent of the ECLS approach, 30-day mortality is still high but with superior 30-day survival for patients with ECLS and left ventricular venting. Moreover, by unloading the ventricle, left ventricular decompression may provide an important time window for recovery or further treatment, such as bridge to bridge or bridge to transplant.

scholarly journals When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock

2015 ◽  
Vol 49 (3) ◽  
pp. 802-809 ◽  
Author(s):  
Sabina P. W. Guenther ◽  
Stefan Brunner ◽  
Frank Born ◽  
Matthias Fischer ◽  
René Schramm ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Refractory Cardiogenic Shock

scholarly journals Thrombotic thrombocytopenic purpura presenting as a severe peripartum cardiogenic shock: Role of myocardial biopsy and assist device for diagnosis and resuscitation

2017 ◽  
Vol 9 (7) ◽  
pp. NP8-NP9 ◽  
Author(s):  
Sébastien Champion ◽  
Dominique Belcour ◽  
Bernard Alex Gaüzère
Keyword(s):  
Cardiogenic Shock ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Cardiac Involvement ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Complete Recovery ◽  
Myocardial Biopsy ◽  
Assist Device ◽  
Thrombocytopenic Purpura

We describe the case of a peripartum thrombotic thrombocytopenic purpura with fulminant cardiogenic shock treated with extracorporeal life support. Thrombotic thrombocytopenic purpura should be considered in the case of thrombotic microangiopathy with several or severe organ involvement and needs emergent treatment with plasmapheresis (with or without rituximab). In the case of cardiac involvement, aggressive treatment should be considered given the high mortality and the potential complete recovery.

scholarly journals Flow manipulation and the association with myocardial contractility during extracorporeal life support (FLAME)

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
SKT Ma ◽  
WC Sin ◽  
CW Ngai ◽  
ASK Wong ◽  
WM Chan ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiogenic Shock ◽  
Myocardial Contractility ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Contractility ◽  
Left Ventricular Contractility ◽  
Extracorporeal Blood

Abstract Funding Acknowledgements Type of funding sources: None. Background Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an advanced technique in extracorporeal life support (ECLS) used to support extreme circulatory failure including patients with cardiac arrest and cardiogenic shock refractory to conventional support. It is a long-standing belief that peripheral V-A ECMO poses increased afterload to the inured heart, but conventional echocardiographic measurements are often insensitive in detecting subtle changes in loading conditions. Purpose This study aimed to evaluate the effects of varying blood flow during peripheral V-A ECMO on intrinsic myocardial contractility, using detailed echocardiographic assessment including speckle tracking echocardiography (STE). Methods Adult patients with acute cardiogenic shock who were supported by peripheral V-A ECMO from April 2019 to September 2020 were recruited. Serial hemodynamic and cardiac performance parameters were measured by transthoracic echocardiogram (TTE) within 48 hours after implementation of V-A ECMO, at different levels of extracorporeal blood flow – 100%, 120% and 50% of target blood flow (TBF). Results A total of 30 patients were included. 22 (71%) were male, and the mean (SD) age was 54 (13) years. The major indications for V-A ECMO were myocardial infarction (19, 63% patients), and myocarditis (5, 17%). With a decrease in extracorporeal blood flow from 100% to 50% of TBF, mean arterial pressure (MAP) dropped from 76+/-3 to 64+/-3mmHg (p <0.001), and cardiac index (CI) increased from 0.89+/-0.13 to 1.27+/-0.18L/min/m2 (p < 0.001). All indices of left ventricular contractility improved at a lower extracorporeal blood flow: the myocardial contractility measured by global longitudinal peak systolic strain (GLPSS) improved from -3+/-0.7% to -5+/-0.8% (p < 0.001); left ventricular ejection fraction (LVEF) increased from 21.5+/-2.6% to 30.9+/-2.7% (p < 0.001) and 19.7+/-3.1% to 28.4+/-3.2% (p < 0.001) by biplane and linear methods, respectively; left ventricular index of myocardial performance (LIMP) improved from 1.51+/-0.12 to 1.03+/-0.09 (p < 0.001). Similar findings were reproduced when comparing left ventricular contractility at extracorporeal blood flows of 120% and 50% of TBF. Conclusions The ECMO blood flow rate in peripheral V-A ECMO is inversely related to myocardial contractility, and is quantifiable by myocardial strain measured by STE.

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