scholarly journals Catheter Ablation in Patients With Cardiogenic Shock and Refractory Ventricular Tachycardia

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Jad A. Ballout ◽  
Oussama M. Wazni ◽  
Khaldoun G. Tarakji ◽  
Walid I. Saliba ◽  
Mohamed Kanj ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Arrhythmia ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mechanical Support ◽  
Ventricular Ejection Fraction ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation

Background: There is paucity of data regarding radiofrequency ablation for ventricular tachycardia (VT) in patients with cardiogenic shock and concomitant VT refractory to antiarrhythmic drugs on mechanical support. Methods: Patients undergoing VT ablation at our center were enrolled in a prospectively maintained registry and screened for the current study (2010–2017). Results: All 21 consecutive patients with cardiogenic shock and concomitant refractory ventricular arrhythmia undergoing bailout ablation due to inability to wean off mechanical support were included. Median age was 61 years, 86% were men, median left ventricular ejection fraction was 20%, 81% had ischemic cardiomyopathy, and PAINESD score was 18±5. The type of mechanical support in place before the procedure was intra-aortic balloon pump in 14 patients (67%), Impella CP in 2, extracorporeal membrane oxygenation in 2, extracorporeal membrane oxygenation and intra-aortic balloon pump in 2, and extracorporeal membrane oxygenation and Impella CP in 1. Endocardial voltage maps showed myocardial scar in 19 patients (90%). The clinical VTs were inducible in 13 patients (62%), whereas 6 patients had premature ventricular contraction–induced ventricular fibrillation/VT (29%), and VT could not be induced in 2 patients (9%). Activation mapping was possible in all 13 with inducible clinical VTs. Substrate modification was performed in 15 patients with scar (79%). After ablation and scar modification, the arrhythmia was noninducible in 19 patients (91%). Seventeen (81%) were eventually weaned off mechanical support successfully, but 6 (29%) died during the index admission from persistent cardiogenic shock. Patients who had ventricular arrhythmia and cardiogenic shock on presentation had a trend toward lower in-hospital mortality compared with those who presented with cardiogenic shock and later developed ventricular arrhythmia. Conclusions: Bailout ablation for refractory ventricular arrhythmia in cardiogenic shock allowed successful weaning from mechanical support in a large proportion of patients. Mortality remains high, but the majority of patients were discharged home and survived beyond 1 year.

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Septic Cardiomyopathy due to Legionella Pneumonia after Influenza Virus Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Motohiro Asaki ◽  
Takamitsu Masuda ◽  
Yasuo Miki
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Myocardial Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Septic Cardiomyopathy ◽  
Altered Level ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Circulatory Insufficiency ◽  
Va Ecmo

A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days’ duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary Legionella antigen test was positive. A diagnosis of septic shock due to Legionella and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors. However, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 since admission. Tachycardia and myocardial dysfunction improved by day 8, and VA-ECMO was withdrawn. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to a recovery hospital on day 108. VA-ECMO may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic cardiomyopathy using catecholamines and β-blockers. It may be necessary to adopt VA-ECMO at an appropriate time before the patient progresses to cardiopulmonary arrest.

Abstract 116: Impella Device Success: Walking Home After Cardiogenic Shock From Ventricular Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Christopher Smith ◽  
Vivek Menon ◽  
Dantwan Smith
Keyword(s):  
Ventricular Fibrillation ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Stunned Myocardium ◽  
Mechanical Support ◽  
Ventricular Ejection Fraction ◽  
Obstructive Sleep ◽  
Management Protocol ◽  
Support Devices

Ventricular fibrillation is a fatal arrhythmia due to its detrimental impact on cardiac output. Managing patients in V-Fib arrest is often challenging, but newer mechanical support devices such as Impella CP 5.0 (Abiomed, Danvers, MD) are proving to be an excellent adjunct to inotrope and vasopressor therapy. We present a 75-year-old female with a medical history of atrial fibrillation and obstructive sleep apnea that presented to the ER unresponsive. On arrival, the patient was pulseless and initial rhythm on telemetry revealed ventricular fibrillation. The patient demonstrated minimally reactive pupils to light, negative corneal reflex, and lower extremity clonus. ROSC was achieved with electric defibrillation and two rounds of CPR. Chest radiograph revealed mild bilateral pulmonary congestion. Head CT revealed no acute intracranial pathology. The patient was placed on targeted temperature management protocol for the next 48 hours. Emergent left heart catheterization revealed no signs of occlusive coronary disease. TTE revealed left ventricular ejection fraction 5-10%, likely from stunned myocardium. The patient continued to clinically decline and decision was made to place an Impella device for further hemodynamic support. Unlike ECMO, the Impella fully unloaded the LV and allowed diastolic coronary filling. The patient ultimately demonstrated significant improvement and repeat TTE revealed an improved EF of 45-50%. Prior to hospital discharge, an AICD was placed for primary SCD prevention. The patient maintained close outpatient follow-up with her cardiologist and PCP. This case illustrates the importance life-saving mechanical support devices such as Impella in the setting of cardiogenic shock, even from non-ischemic ventricular fibrillation.

scholarly journals Percutaneous coronary intervention under temporary peripheral veno-arterial extracorporeal membrane oxygenation

2016 ◽  
Vol 9 (8) ◽  
pp. NP3-NP5 ◽  
Author(s):  
Jawad Chaara ◽  
Mustafa Cikirikcioglu ◽  
Marco Roffi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Heart Team ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Percutaneous Coronary ◽  
Artery Disease

We describe the case of a 68-year old female presenting with subacute ST-elevation myocardial infarction and severe depressed left ventricular ejection fraction (15%) in the presence of severe three-vessel coronary artery disease. The patient was haemodynamically stable. After heart team discussion, a percutaneous coronary intervention was performed under peripheral veno-arterial extracorporeal membrane oxygenation without complications.

scholarly journals Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic

Circulation ◽  
2020 ◽  
Vol 142 (5) ◽  
pp. 429-436 ◽  
Author(s):  
Zahra Belhadjer ◽  
Mathilde Méot ◽  
Fanny Bajolle ◽  
Diala Khraiche ◽  
Antoine Legendre ◽  
...  
Keyword(s):  
Heart Failure ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Inflammatory State ◽  
Inflammatory Syndrome

Background: Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention. Methods: Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state. Results: Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2–16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned. Conclusions: Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.

scholarly journals Predictors of Extracorporeal Membrane Oxygenation Support for Children with Acute Myocarditis

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Han-Ping Wu ◽  
Mao-Jen Lin ◽  
Wen-Chieh Yang ◽  
Kang-Hsi Wu ◽  
Chun-Yu Chen
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Primary Care Physicians ◽  
Troponin I ◽  
Acute Myocarditis ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Treatment Modalities ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation

The clinical presentation of acute myocarditis in children may range from asymptomatic to sudden cardiac arrest. This study analyzed the clinical spectrum of acute myocarditis in children to identify factors that could aid primary care physicians to predict the need for extracorporeal membrane oxygenation (ECMO) earlier and consult the pediatric cardiologist promptly. Between October 2011 and September 2016, we retrospectively analyzed 60 patients aged 18 years or younger who were admitted to our pediatric emergency department with a definite diagnosis of acute myocarditis. Data on demographics, presentation, laboratory tests, electrocardiogram and echocardiography findings, treatment modalities, complications, and long-term outcomes were obtained. During the study period, 60 patients (32 male, 28 female; mean age, 8.8±6.32 years) were diagnosed with acute myocarditis. Fever, cough, and chest pain were the most common symptoms (68.3%, 56.7%, and 53.3%, resp.). Arrhythmia and left ventricular ejection fraction (LVEF) < 60%, vomiting, weakness, and seizure were more common in the ECMO group than in the non-ECMO group, with statistical significance (P<0.05). Female sex, vomiting, weakness, seizure, arrhythmia, and echocardiography showing LVEF < 60% may predict the need for ECMO. Initial serum troponin-I cutoff values greater than 14.21 ng/mL may also indicate the need for ECMO support for children with acute myocarditis.

P1713Predictors of mortality following extracorporeal membrane oxygenation support in a large unselected critically ill patient population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B T Nemeth ◽  
I F Edes ◽  
I Hartyanszky ◽  
B Szilveszter ◽  
L Fazekas ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Patient Population ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Critically Ill Patient ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Va Ecmo

Abstract Background Mechanical circulatory support (MCS) has been established as a means of augmenting circulation in critically ill patients due to a variety of underlying clinical reasons. Different methods of MCS may be applied with the venous-arterial extracorporeal membrane oxygenation (VA-ECMO) system being one of the most utilized in everyday care. Objectives Our aim was to determine independent predictors of mortality following VA-ECMO therapy in a large, unselected, adult, critically ill patient population requiring MCS. Methods Data on 181 consecutive, real-world VA-ECMO treatments have been assessed. Analysis was conducted for all subjects requiring MCS with the VA-ECMO as first instalment, regardless of underlying cause or eventual upgrade. All potential clinical factors influencing mortality were examined and evaluated. Results Overall mortality amounted to ≈65% at a median follow-up of 28 days and depended upon: glomerular filtration rate of <60 ml/min/1.73 m2 (HR: 1.53; p=0.03) and age ≥65 years (HR: 1.65; p=0.02) based on multivariate Cox regression analysis. However, prolonged ECMO time, conversion of the ECMO to longer duration MCS, diabetes, prior ACS or revascularization, reduced left ventricular ejection fraction (EF) had no effect on adverse mortality outcomes (all p>0.05). Surprisingly, neither the need for resuscitation during MCS nor any ECMO implantation indication influenced mortality by itself (p>0.05). Conclusions We have found that mortality in critically ill patients requiring VA-ECMO use remains very high. Decreased renal function and advanced age were found to influence mortality in our all-comers patient population, while traditional predictors of cardiovascular mortality did not have a significant effect on survival.

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 Combination of veno-arterial extracorporeal membrane oxygenation and hypothermia for out-of-hospital cardiac arrest due to Taxus intoxication

CJEM ◽  
2014 ◽  
Vol 16 (06) ◽  
pp. 504-507 ◽  
Author(s):  
Aurélie Thooft ◽  
Ahmed Goubella ◽  
David Fagnoul ◽  
Fabio S. Taccone ◽  
Serge Brimioulle ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Taxus Baccata ◽  
Tree Leaves ◽  
Ventricular Ejection Fraction ◽  
Membrane Oxygenation ◽  
Yew Tree

Abstract A young woman presented with cardiac arrest following ingestion of yew tree leaves of the Taxus baccata species. The toxin in yew tree leaves has negative inotropic and dromotropic effects. The patient had a cardiac rhythm that alternated between pulseless electrical activity with a prolonged QRS interval and ventricular fibrillation. When standard resuscitation therapy including digoxin immune Fab was ineffective, a combination of extracorporeal membrane oxygenation (ECMO) and hypothermia was initiated. The total duration of low flow/no flow was 82 minutes prior to the initiation of ECMO. After 36 hours of ECMO (including 12 hours of electrical asystole), the patient’s electrocardiogram had normalized and the left ventricular ejection fraction was 50%. At this time, dobutamine and the ECMO were stopped. The patient had a full neurologic recovery and was discharged from the intensive care unit after 5 days and from the hospital 1 week later.

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