Left Heart Decompression in Acute Complicated Myocardial Infarction During Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 32 (6) ◽  
pp. 405-408 ◽  
Author(s):  
Seok In Lee ◽  
So Young Lee ◽  
Chang Hyu Choi ◽  
Kook Yang Park ◽  
Chul-Hyun Park
Keyword(s):  
Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Wall Stress ◽  
Left Ventricular ◽  
Papillary Muscle Rupture ◽  
Membrane Oxygenation ◽  
Mechanical Complications ◽  
Myocardial Wall ◽  
Myocardial Wall Stress

Acute myocardial infarction (AMI) can progress to cardiogenic shock and mechanical complications. When extracorporeal membrane oxygenation (ECMO) is applied to a patient with AMI with cardiogenic shock and mechanical complications, left ventricular (LV) decompression is an important recovery factor because LV dilation increases myocardial wall stress and oxygen consumption. The authors present the case of a 72-year-old man with AMI and LV dilation who developed cardiogenic shock and papillary muscle rupture and who was treated successfully by ECMO with a left atrial venting.

scholarly journals Post-myocardial infarction left ventricular septal dissecting aneurysm: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Kamikawa ◽  
Takeki Ohashi ◽  
Masao Tadakoshi ◽  
Akinori Kojima ◽  
Hirotaka Yamauchi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Interventricular Septum ◽  
Stable Condition ◽  
Major Complication ◽  
Left Ventricular ◽  
Post Myocardial Infarction ◽  
Extra Corporeal Membrane Oxygenation ◽  
Papillary Muscle Rupture ◽  
Membrane Oxygenation

Abstract Background Post-infarction perforation of the ventricular septum is recognized as a major complication of post-myocardial infarction. However, post-infarction ventricle dissection is seldom reported, as the ventricular shunt often accompanying this condition is a significant cause of cardiogenic shock. We encountered a rare case of ventricular dissection unaccompanied by a shunt, which caused a state of shock. Case presentation A 67-year-old man was diagnosed with acute myocardial infarction with a left ventricular oozing rupture. The occlusion of the left anterior descending artery was aspirated, followed by drainage of the pericardial bleeding and hemostasis of the left ventricle. After 15 h, he presented with sudden cardiogenic shock requiring extra-corporeal membrane oxygenation. The transesophageal echocardiogram showed a left ventricular septal aneurysm. Five days later, he underwent an operation, in which a ventricular septal wall dissection with a tear-forming large pseudoaneurysm was found. The tear was closed with a patch. He was weaned off extra-corporeal membrane oxygenation the next day. Αfter 4 months, he was discharged in a stable condition. Conclusions Recognizing and identifying the cause of cardiogenic shock after myocardial infarction is crucial to provide the best treatment and surgical approach. Ventricular septal dissection should be considered, in addition to the usual complications, such as possible papillary muscle rupture, cardiac rupture, and perforation of the interventricular septum.

scholarly journals Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock

2020 ◽  
Vol 23 (6) ◽  
pp. E888-E894
Author(s):  
Weimin Li ◽  
Dongyan Yang
Keyword(s):  
Myocardial Infarction ◽  
Survival Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Fulminant Myocarditis ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Primary Disease

Background: Many clinicians do not know under what exact conditions extracorporeal membrane oxygenation (ECMO) can get the best results. In this study, we explored the optimal indications for ECMO in patients with refractory cardiogenic shock. Methods: From October 2014 to November 2019, 23 patients with refractory cardiogenic shock were treated with ECMO in our hospital, including 11 cases with acute left anterior myocardial infarction, 3 with acute left inferior and right ventricular myocardial infarction, and 9 with fulminant myocarditis. These cases were divided into survivors (n = 10) and nonsurvivors (n = 13), and the clinical data of the 2 groups were compared. Results: The weaning rate of ECMO was 60.9%. The discharge survival rate was 43.5%. There were significant differences in age, sequential organ failure assessment (SOFA) score, vasoactive-inotropic (VIS) score, lactic acid concentrations, primary disease, and smoking history between survivors and nonsurvivors before ECMO (P < .05). There were significant differences in blood pressure (systolic and diastolic), oxygen partial pressure, and left ventricular ejection fraction between survivors and nonsurvivors 1 day before the removal of ECMO (P < .05). Conclusions: The reversibility of the primary disease causing refractory cardiogenic shock is critical to the survival rate of ECMO. Etiological treatment is essential, and extra attention should be paid to the use of ECMO in patients with irreversible primary disease. ECMO should be regarded as a first aid device and is not suitable for long-term cardiac assistance; left ventricular assist or heart transplantation is a better option.

scholarly journals Outcomes of extracorporeal membrane oxygenation with or without left ventricular unloading devices in patients with non-myocardial infarction cardiogenic shock

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K K Kurpad ◽  
S S Sohal ◽  
H M Mehta ◽  
G V Visveswaran ◽  
R T Tayal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Length Of Stay ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Left Ventricular ◽  
Specific Patient ◽  
Membrane Oxygenation ◽  
Va Ecmo

Abstract Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is being increasingly used to treat cardiogenic shock, however its effect on increasing left ventricular (LV) afterload may slow myocardial recovery and negatively affect survival. Percutaneous mechanical support devices have been utilized for LV unloading by reducing afterload in an attempt to improve outcomes. While the use of LV unloading devices remains debatable, its use has not been specifically studied in patients with non-acute myocardial infarction cardiogenic shock (non-AMICS). Purpose To study the outcomes of VA-ECMO with or without LV unloading devices in patients with non-AMICS patients. Methods National inpatient sample database from years 2015 to 2018 was queried to select patients admitted with non-AMICS. Patients were included in the study if they underwent VA-ECMO during admission and later categorized into 3 groups i.e. VA-ECMO, VA-ECMO plus Impella and VA-ECMO plus intra-aortic balloon pump (IABP). Baseline demographics and in-hospital outcomes were compared between the 3 pre-specified groups. Statistical significance was assigned at p&lt;0.05. Results 178,605 patients met criteria for non-AMICS. Of these, 2190 (1.23%) patients received VA-ECMO alone, 965 (0.54%) received VA-ECMO plus IABP and 414 (0.23%) received VA-ECMO plus Impella. On univariate analysis, patients who received VA-ECMO alone had higher rates of inpatient mortality as compared to those who received VA-ECMO plus IABP or VA-ECMO plus Impella (39.04%, 33.72% and 25.81% respectively, p=0.001). On multivariate analysis, the patients who received VA-ECMO plus IABP or VA-ECMO plus Impella had lower odds of mortality when compared to VA-ECMO alone (OR: 0.61 (0.39–0.96), p=0.03), OR: 0.51 (0.23–1.08), p=0.08). The length of stay and cost were significantly higher for patients with VA-ECMO with unloading devices (IABP or Impella) compared with VA-ECMO alone (24.77±2.44 and 27.74±3.55 days vs 23.70±1.25 days respectively. p=0.001, $846,404±71169 and 860,999±121942 vs $740,274±43644 respectively, p=0.001). Conclusions Non AMICS patients who received VA-ECMO along with LV unloading devices (esp IABP) had lower in-hospital mortality as compared to those who received VA-ECMO alone despite having longer length of stay and higher cost. Use of LV unloading devices like IABP or Impella may improve outcomes in patients requiring VA-ECMO support for non-myocardial infarction cardiogenic shock. Further studies are needed to identify specific patient subsets that may benefit from this approach. FUNDunding Acknowledgement Type of funding sources: None.

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.

Abstract 13306: Impella Combined With Extracorporeal Membrane Oxygenation Synergistically Unloads the Left Ventricle and Reduces Infarct Size in a Model of Myocardial Infarction With Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Genya Sunagawa ◽  
Keita Saku ◽  
Takuya Nishikawa ◽  
Nobuhiro Suematsu ◽  
Toru Kubota ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Infarct Size ◽  
Coronary Arteries ◽  
Myocardial Infarct ◽  
Left Ventricular ◽  
Assist Device ◽  
Acute Myocardial Infarct ◽  
Membrane Oxygenation ◽  
Coronary Ligation

Introduction: Extracorporeal membrane oxygenation (ECMO) supports hemodynamics in cardiogenic shock (CS) at the expense of left ventricular (LV) overload. LV assist device (LVAD) also supports hemodynamics, whereas LVAD unloads LV. Therefore, the combination of ECMO and LVAD would augment hemodynamic support and unload LV. We hypothesized that the combination therapy in acute myocardial infarct (AMI) in CS could synergistically improve hemodynamics and unload LV, which, in turn, reduces infarct size. Methods: In protocol 1, we ligated coronary arteries and created AMI with CS in 5 mongrel dogs (15.1±0.3 kg). We transvascularly introduced Impella CP into LV. We kept the ECMO flow constant at 1.8L/min. We compared hemodynamics and the LV pressure-volume area (PVA, an index of LV oxygen consumption) under 3 conditions; Control, ECMO, and ECMO+Impella (ECPELLA) in each dog. In protocol 2 (n=15), we ligated coronary arteries for 180 min and then reperfused. We activated Impella CP and/or ECMO from 60 min after the coronary ligation to the end of the experiment. We allocated dogs into 3 groups, no support (Control), ECMO, and ECPELLA and compared infarct size at 180 min after reperfusion among 3 groups. Results: In protocol 1, both ECMO and ECPELLA increased arterial pressure compared to Control (Control: 63±9, ECMO: 88±10 and ECPELLA: 97±18 mmHg, p < 0.05), and resolved the CS status. ECPELLA strikingly reduced PVA by 83% relative to Control (1500±326, 2038±357 and 258±182 mmHg*ml, p<0.001). In protocol 2, ECPELLA markedly reduced the infarct size (15±8%) compared to Control (53±7%, p<0.05) and ECMO (39±10%, p<0.05). Conclusions: ECPELLA before reperfusion markedly improved hemodynamics, reduced PVA, and limited infarct size in a dog model of MI with CS. ECPELLA could prevent ECMO-induced LV overload and synergistically exert powerful anti-infarct effects in AMI with CS.

Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock

2017 ◽  
Vol 26 (4) ◽  
pp. 314-316 ◽  
Author(s):  
Nadia Bouabdallaoui ◽  
Denis Bouchard ◽  
E. Marc Jolicoeur ◽  
Alexandra Chronopoulos ◽  
Pierre Y Garneau ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Clinical Value ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support ◽  
Life Saving ◽  
Adrenal Pheochromocytoma ◽  
Life Threatening

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.

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