scholarly journals Biventricular Impella (Bi-Pella) in Refractory Cardiogenic Shock: The First Case from the Middle East

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Abdulaziz Almejren ◽  
Abdullah Alenezi
Keyword(s):  
Cardiogenic Shock ◽  
Venous Pressure ◽  
Myocardial Infarctions ◽  
Central Venous ◽  
Cardiac Power ◽  
Refractory Cardiogenic Shock ◽  
First Case ◽  
Venous Oxygen Saturation ◽  
Biventricular Failure ◽  
Hospital Morbidity

Cardiogenic shock (CS) associated with biventricular failure (BiVF) carries significant in-hospital morbidity and mortality. We describe here the successful use of percutaneous biventricular Impella (Bi-Pella) for cardiogenic shock secondary to acute biventricular myocardial infarctions (AMI-CS), as guided by parameters such as mixed venous oxygen saturation (SvO2), pulmonary artery pulsatility index (PAPi), central venous pressure (CVP), and cardiac power output (CPO). We aim to highlight the promising outcomes of timely implanted biventricular Impella in (AMI-CS).

scholarly journals Comparison of left ventricular unloading strategies on venoarterial extracorporeal life support

2020 ◽  
Author(s):  
Ali İhsan Hasde ◽  
Mehmet Cahit Sarıcaoğlu ◽  
Nur Dikmen Yaman ◽  
Çağdaş Baran ◽  
Evren Özçınar ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Central Venous Pressure ◽  
Venous Pressure ◽  
Neurological Complications ◽  
Left Ventricular ◽  
Central Venous ◽  
Refractory Cardiogenic Shock ◽  
Pulmonary Capillary ◽  
Va Ecmo ◽  
Wedge Pressure

Abstract OBJECTIVES Our goal was to compare the haemodynamic effects of different mechanical left ventricular (LV) unloading strategies and clinical outcomes in patients with refractory cardiogenic shock supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). METHODS A total of 448 patients supported with VA-ECMO for refractory cardiogenic shock between 1 March 2015 and 31 January 2020 were included and analysed in a single-centre, retrospective case–control study. Fifty-three patients (11.8%) on VA-ECMO required LV unloading. Percutaneous balloon atrial septostomy (PBAS), intra-aortic balloon pump (IABP) and transapical LV vent (TALVV) strategies were compared with regards to the composite rate of death, procedure-related complications and neurological complications. The secondary outcomes were reduced pulmonary capillary wedge pressure, pulmonary artery pressure, central venous pressure, left atrial diameter and resolution of pulmonary oedema on a chest X-ray within 48 h. RESULTS No death related to the LV unloading procedure was detected. Reduction in pulmonary capillary wedge pressure was highest with the TALVV technique (17.2 ± 2.1 mmHg; P < 0.001) and was higher in the PBAS than in the IABP group; the difference was significant (9.6 ± 2.5 and 3.9 ± 1.3, respectively; P = 0.001). Reduction in central venous pressure with TALVV was highest with the other procedures (7.4 ± 1.1 mmHg; P < 0.001). However, procedure-related complications were significantly higher with TALVV compared to the PBAS and IABP groups (50% vs 17.6% and 10%, respectively; P = 0.015). We observed no significant differences in mortality or neurological complications between the groups. CONCLUSIONS Our results suggest that TALVV was the most effective method for LV unloading compared with PBAS and IABP for VA-ECMO support but was associated with complications. Efficient LV unloading may not improve survival.

scholarly journals Awake Implementation of Extracorporeal Life Support in Refractory Cardiogenic Shock

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 43
Author(s):  
Julia Riebandt ◽  
Thomas Haberl ◽  
Klaus Distelmaier ◽  
Martin H. Bernardi ◽  
Anne-Kristin Schaefer ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Venous Pressure ◽  
Organ Function ◽  
Central Venous ◽  
Therapy Options ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels ◽  
Organ Replacement

Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated with the need for sedation and intubation. The aim of the study was the assessment of safety and feasibility of awake ECLS implementation and of outcomes in patients treated with this concept. Materials and Methods: We retrospectively reviewed the concept of awake ECLS implantation in 16 consecutive patients (mean age 58 ± 8 years; male: 88%; ischemic cardiomyopathy: 50%) from 02/2017 to 01/2021. Study endpoints were survival to weaning or bridging to durable support or organ replacement and development of end-organ function and hemodynamic parameters on ECLS. Results: Fourteen patients (88%) were able to be successfully transitioned to definite therapy options. ECLS support stabilized end-organ function, led to a decrease in mean lactate levels (5.3 ± 3.7 mmol/L at baseline to 1.9 ± 1.3 mmol/L 12 h after ECLS start; p = 0.01) and improved hemodynamics (median central venous pressure 20 ± 5 mmHg vs. 10 ± 2 mmHg, p = 0.001) over a median duration of two days (1–8 days IQR). Two patients (13%) died on ECLS support due to multi-organ dysfunction syndrome. Survival to discharge of initially successfully bridged or weaned patients was 64%. Conclusions: Awake ECLS implantation is feasible and safe with the key advantage of omitting or delaying general anesthesia and intubation, with their associated risks in cardiogenic-shock patients, facilitating further decision making.

Distributive Shock

2017 ◽  
Author(s):  
Angela Lee ◽  
Gebhard Wagener
Keyword(s):  
Venous Pressure ◽  
Clinical Manifestations ◽  
Acute Circulatory Failure ◽  
Central Venous ◽  
Compensatory Mechanisms ◽  
Shock State ◽  
Therapeutic Goals ◽  
Venous Oxygen Saturation ◽  
Distributive Shock ◽  
Organ Manifestations

The distributive shock chapter reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on the pathogenesis of shock. It reviews the compensatory mechanisms in shock that cause symptoms and organ manifestations in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion to reverse the shock state.

scholarly journals Three-Dimensional inferior vena cava for assessing central venous pressure in patients with cardiogenic shock

2019 ◽  
Vol 11 (1) ◽  
pp. e291-e292
Author(s):  
R. Huguet ◽  
Damien. Fard ◽  
Thomas. D’humières ◽  
O. Brault-Meslin ◽  
Louis. Nahory ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cardiogenic Shock ◽  
Central Venous Pressure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Three Dimensional ◽  
Vena Cava ◽  
Central Venous

scholarly journals Management of cesarean section in a patient with Fontan circulation: a case report of dramatic reduction of maternal oxygen consumption after delivery

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Kazutomo Saito ◽  
Hiroaki Toyama ◽  
Atsushi Okamoto ◽  
Masanori Yamauchi
Keyword(s):  
Oxygen Consumption ◽  
Cesarean Section ◽  
Anesthetic Management ◽  
Venous Pressure ◽  
Central Venous Oxygen Saturation ◽  
Central Venous ◽  
Case Presentation ◽  
Venous Oxygen Saturation ◽  
Combined Spinal Epidural Anesthesia ◽  
Spinal Epidural

Abstract Background The anesthetic management of cesarean sections in Fontan-palliated parturients requires strict hemodynamic control. However, patient management with central venous oxygen saturation (ScvO2) and oxygen consumption (VO2) has never been reported. Case presentation A 30-year-old woman, who had received a total cavopulmonary connection for tricuspid atresia, was planned to undergo cesarean section at 38 weeks’ gestation. During combined spinal-epidural anesthesia, ScvO2 in addition to arterial pressure-based cardiac output (APCO) and central venous pressure (CVP) was monitored, and the change of VO2 was evaluated. After delivery, her APCO was almost unchanged. However, her ScvO2 increased dramatically from 42.1 to 67.3% and her CVP increased from 9 to 11 mm Hg. The calculated mean maternal VO2 changed from 443 to 295 mL/min. Conclusions In a cesarean section for a Fontan-palliated parturient, ScvO2 dramatically increased and maternal VO2 decreased by more than 25% after delivery.

scholarly journals Fluid therapy for septic shock resuscitation: which fluid should be used?

2015 ◽  
Vol 13 (3) ◽  
pp. 462-468 ◽  
Author(s):  
Thiago Domingos Corrêa ◽  
Leonardo Lima Rocha ◽  
Camila Menezes Souza Pessoa ◽  
Eliézer Silva ◽  
Murillo Santucci Cesar de Assuncao
Keyword(s):  
Septic Shock ◽  
Venous Pressure ◽  
Central Venous Oxygen Saturation ◽  
Tissue Perfusion ◽  
Central Venous ◽  
Initial Resuscitation ◽  
Increased Risk ◽  
Venous Oxygen Saturation ◽  
Crystalloid Solutions ◽  
Lactate Levels

Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.

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