Biventricular Compared to Left Ventricular Impella and Norepinephrine Support in a Porcine Model of Severe Cardiogenic Shock

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nanna L.J. Udesen ◽  
Jakob Josiassen ◽  
Ole K.L. Helgestad ◽  
Ann B.S. Banke ◽  
Peter H. Frederiksen ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Porcine Model ◽  
Left Ventricular ◽  
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.

P5738Multicenter analysis of left ventricular unloading on top of VA-ECMO for treatment of cardiogenic shock

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Schrage ◽  
S Dabboura ◽  
H Bezerra ◽  
J M Sinning ◽  
H Thiele ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiopulmonary Resuscitation ◽  
Cardiogenic Shock ◽  
Primary Endpoint ◽  
Left Ventricular ◽  
Predictors Of Outcome ◽  
Severe Cardiogenic Shock ◽  
All Cause Mortality ◽  
Va Ecmo

Abstract Background Veno-arterial extracorporeal membrane oxygenation therapy (VA-ECMO) is increasingly used for treatment of severe cardiogenic shock, although it causes an increase in left ventricular (LV) afterload and might therefore hamper myocardial recovery. Recently, the addition of catheter-based left ventricular assist device (cLVAD) on top of VA-ECMO has been used to unload the LV and to improve outcome measures. However, there is limited data on predictors of outcome in this high-risk population. Aim The aim of this study was to evaluate predictors of 30-day survival in a multicentre cohort of severe cardiogenic shock patients treated with cLVADon top of VA-ECMO. Material and methods We report on consecutive patients from six tertiary care centers being treated with cLVAD in addition to VA-ECMO for treatment of cardiogenic shock. The primary endpoint is 30-day all-cause mortality. To identify predictors of the primary endpoint, multivariate analysis using an “elastic net” variable selection algorithm was done after imputation of missing variables. Results A total of 220 patients treated with cLVAD on top of VA-ECMO were included in the analysis. Of these, 79.1% were male with a median age of 55.5 (25thpercentile 48.0, 75thpercentile 65.6) years. In 60.5% of the patients, acute myocardial infarction was the underlying cause of cardiogenic shock and in 44.6% VA-ECMO was used for refractory cardiac arrest (eCPR). In the multivariable analysis, the following baseline parameters were significantly associated with the primary endpoint: Age (odds ratio of 1.68 per standard deviation), duration of cardiopulmonary resuscitation (OR 2.08 per SD), lactate (OR 1.04 per SD) and time from onset of shock to VA-ECMO (OR 1.30 per SD). Conclusion and outlook In this large-scale multicentre analysis of severe cardiogenic shock patients treated with VA-ECMO plus additional cLVAD unloading, age, duration of cardiopulmonary resuscitation, lactate and time from onset of shock to VA-ECMO were significantly associated with 30-day all-cause mortality. To further investigate this topic, we will evaluate predictors of outcome in distinct patient populations such as acute myocardial infarction vs. acute heart failure and patients without vs. patients with prior cardiopulmonary association.

scholarly journals Short-term use of “ECMELLA” in the context of fulminant eosinophilic myocarditis with cardiogenic shock

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mintje Bohné ◽  
Da-Un Chung ◽  
Eike Tigges ◽  
Hendrick van der Schalk ◽  
Daniela Waddell ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Left Ventricular ◽  
Fulminant Myocarditis ◽  
Circulatory Support ◽  
Histopathological Diagnosis ◽  
Severe Cardiogenic Shock ◽  
Hemodynamic Deterioration ◽  
Eosinophilic Myocarditis ◽  
Va Ecmo

Abstract Background Eosinophilic myocarditis (EM) is a rare form of myocarditis. Clinical presentation is various, includes cardiogenic shock and can often be fatal. Diagnosis is based on myocardial eosinophilic infiltration in endomyocardial biopsy. Mechanical circulatory support (MCS) is often required in patients suffering from severe cardiogenic shock. Among the available MCS options the “ECMELLA” concept, a combination of left ventricular venting by Impella® device and extracorporeal life support (ECLS) is possibly able to provide the necessary time frame for diagnostics and initiation of anti-inflammatory medication in patients with fulminant myocarditis. Case presentation We report a case of a 38‐year‐old woman who was presented to us in severe cardiogenic shock, quickly requiring hemodynamic support by an Impella CP® device. Further dramatic hemodynamic deterioration accompanied by multi-organ dysfunction required escalation of MCS via ECLS as veno‐arterial extracorporeal membrane oxygenation (VA-ECMO). After histopathological diagnosis of EM, our patient was put on immunosuppressive therapy with prednisolone. Recovery of both right and left ventricular function allowed explanation of VA-ECMO on day 4 and further hemodynamic improvement allowed removal of the Impella® device on day 9. The patient was discharged after 7 weeks with fully restored cardiac function and in a good neurological state. Conclusions In severe cardiac shock due to fulminant EM the ECMELLA concept as bridge-to-recovery seems to be a valid option to provide the required time for diagnostics and specific therapy.

scholarly journals Impact of concomitant vasoactive treatment and mechanical left ventricular unloading in a porcine model of profound cardiogenic shock

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nanna L. J. Udesen ◽  
Ole K. L. Helgestad ◽  
Ann B. S. Banke ◽  
Peter H. Frederiksen ◽  
Jakob Josiassen ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Porcine Model ◽  
Left Ventricular

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Electrical Injury Induced Cardiogenic Shock Support: A Case Report

2020 ◽  
Author(s):  
Tamer Jamal ◽  
Amjad Shalabi ◽  
Liza Grosman-Rimon ◽  
Diab Ghanim ◽  
Offer Amir ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
High Voltage ◽  
Left Ventricular ◽  
Cardiac Massage ◽  
Electrical Injury ◽  
Membrane Oxygenation ◽  
Severe Cardiogenic Shock ◽  
Va Ecmo

Abstract Background High voltage electrical injury (HVEI) of more than 1,000V is a potentially devastating form of a multisystem injury associated with high morbidity and mortality. We present the first case of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a life saving device for treating a patient with severe cardiogenic shock after a high voltage electrical injury.Case Presentation A 26-year-old male sustained HVEI while working with a concrete mixer pump that came in contact with a high voltage cable of 10,000 volts. He was immediately disconnected from the mixer pump, underwent cardiopulmonary resuscitation and was transported to the nearest medical centre with severe cardiogenic shock with an ejection fraction (EF) of < 10%. Upon arrival, he was in critical condition, sedated and mechanically ventilated, haemodynamically unstable and supported by intravenous (IV) inotropes after a few events of ventricular fibrillation, with an electrical entry point on the left hand and an exit point located on his right leg. Blood pH was 6.8, PCO2 53 mmHg, PaO2 of 57 mmHg, lactate 8 mmol/L, and Troponin 38000 ng/dl. The EF was 10% with global severe left ventricular dysfunction. During cardiopulmonary resuscitation (CPR), including cardiac massage and few electrical shocks, he was immediately connected to the VA-ECMO via open right femoral approach with distal arterial leg perfusion.He was treated with IV broad spectrum antibiotics, and high volume fluids to prevent rhabdomyolysis-induced acute kidney injury, total parenteral nutrition, topical silver sulfadiazine cream, and Granuflex for severe electrical burns. He was gradually weaned from inotropes over the next 3 days, during which his clinical condition and bloodwork improved tremendously. His EF gradually increased to 50% and he was weaned from the VA-ECMO, and underwent decannulation 86 hours after initialization. He was discharged on day 27 without any sequelae.Conclusion The VA-ECMO treatment can be a lifesaving device for treating severe cardiogenic shock caused by high voltage electrical injury, and should be considered while treating these “high-mortality risk” patients.

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.

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