scholarly journals Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure

2014 ◽  
Vol 9 (1) ◽  
Author(s):  
Alexander Weymann ◽  
Bastian Schmack ◽  
Anton Sabashnikov ◽  
Christopher T Bowles ◽  
Philipp Raake ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Refractory Cardiogenic Shock ◽  
Lung Failure

Multiple Organ Failure and Refractory Cardiogenic Shock due to Venlafaxine Intoxication, Successfully Treated with Veno-Arterial Extracorporeal Life Support

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Painvin B ◽  
◽  
Le Balc’h P ◽  
Gicquel T ◽  
Camus C ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Multiple Organ Failure ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Multiple Organ ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prolonged Release ◽  
Refractory Cardiogenic Shock

Venlafaxine has critical side effects from arrhythmias to cardiogenic shock after toxic dose ingestion. We report a case of venlafaxine intoxication with Multiple Organ Failure (MOF) treated with Veno-Arterial Extracorporeal Life Support (VA-ECLS). A 60-year old male with a history of chronic depression ingested 72 tablets of prolonged-release venlafaxine hydrochloride 75 mg (total 5400 mg). Initial EKG showed broadened QRS complexes and Transthoracic Echocardiography (TTE) revealed diffuse ventricular hypokinesia with Left Ventricular Ejection Fraction (LVEF) of 15% for which dobutamine infusion was started. Due to persistent refractory cardiogenic shock and MOF, a Medos® Deltastream® VA-ECLS was surgically implanted in our intensive care unit. On day 1, toxicology analysis found plasma concentrations of venlafaxine 3.2mg/L and its metabolite desmethylvenlafaxine at 0.92 mg/L. At day 6, we performed a weaning trial, enabling ECLS removal. Motion defect of anteroseptal and inferolateral walls was also noticed. EKGs showed a shorten R wave in the anteroseptal territory leading to the potential diagnosis of underlying ischemic cardiomyopathy. The patient was extubated at day-10 and discharged for cardiology unit at day-17. At day-20, cardiac magnetic resonance imaging showed no sign of ischemia and TTE parameters were normalized. This is the first report of refractory cardiogenic shock and MOF due to venlafaxine intoxication treated with VA-ECLS. The main objective of ECLS is to restore cardiac output especially when ventricular failure is refractory to inotropes. Our experience suggests that MOF secondary to refractory cardiogenic shock should quickly prompt the implantation of a VA-ECLS in venlafaxine critical overdose.

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 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.

scholarly journals Inverted takotsubo syndrome complicated with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation in a patient with bilateral pheochromocytoma: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-5
Author(s):  
Bebiana Manuela Monteiro Faria ◽  
João Português ◽  
Roberto Roncon-Albuquerque Jr ◽  
Rodrigo Pimentel
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Lv Function ◽  
Takotsubo Syndrome ◽  
Membrane Oxygenation ◽  
Lv Dysfunction

Abstract Background Takotsubo syndrome (TS) is characterized by a transient left ventricular (LV) dysfunction and rarely presents with cardiogenic shock (CS). Inverted TS (ITS) is a rare entity associated with the presence of a pheochromocytoma. Case summary We present a case of a young woman was admitted to the emergency department due to intense headache, chest discomfort, palpitations, and breathlessness. An ITS secondary to a pheochromocytoma crisis presenting with CS was diagnosed. The patient was managed with veno-arterial extracorporeal membrane oxygenation, until recovery of LV function. On the 35th day of hospitalization, open bilateral adrenalectomy was performed. Discussion Takotsubo syndrome patients presenting with CS are challenging and clinicians should be aware of underlying causes. Specific triggers such as pheochromocytoma should systematically be considered particularly if ITS was presented. Extracorporeal life support devices could provide temporary mechanical circulatory support in patients with TS on refractory CS and help to manage complex cases with TS due to pheochromocytoma.

scholarly journals OUTCOME OF ELDERLY PATIENTS UNDERGOING EXTRACORPOREAL LIFE SUPPORT IN REFRACTORY CARDIOGENIC SHOCK

2017 ◽  
Vol 69 (11) ◽  
pp. 1186
Author(s):  
Suzanne de Waha ◽  
Steffen Desch ◽  
Tobias Graf ◽  
Georg Fuernau ◽  
Ingo Eitel ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Refractory Cardiogenic Shock

scholarly journals Trans-Aortic or Pulmonary Artery-Based Drainage for Left Ventricular Unloading and Veno-Arterial Extracorporeal Life Support Management in a Porcine Cardiogenic Shock Model.

2020 ◽  
Author(s):  
Paolo Meani ◽  
Mikulas Mlcek ◽  
Mariusz Kowalewski ◽  
Giuseppe Maria Raffa ◽  
Federica Jiritano ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Blood Stasis ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Stroke Work ◽  
Organ Perfusion ◽  
Suction Device

Abstract Background The use of peripheral veno-arterial extracorporeal life support (V-A ECLS) as a mechanical circulatory support in cardiogenic shock has increased dramatically over the last years. However, increased afterload may jeopardize left ventricle (LV) recovery and cause blood stasis and pulmonary edema. Therefore, several LV unloading techniques have been developed and used with limited understanding of the actual difference among them. The aim of the present study was to compare a trans-aortic suction device (Impella) and pulmonary artery (PA) drainage, for LV unloading and V-A ECLS management as well as efficacy in a porcine cardiogenic shock (CS) model Methods A dedicated CS model compared included twelve female swine (21± 1,8-weeks old and weighing 54,3 ± 4,6 kg) supported with V-A ECLS and randomized to Impella or PA-related LV drainage. LV unloading and end-organ perfusion were evaluated through the pulmonary artery catheter and the LV pressure/volume analysis. All the variables were collected at baseline, profound CS, V-A ECLS support with maximum flow and when Impella or PA cannula run on top. Results CS was successfully induced in all twelve animals. Impella resulted in a marked drop of LVEDV compared to a slight decrease in the PA cannula group, resulting in an overall stroke work (SW) and Pressure-Volume Area (PVA) reductions with both techniques. However, SW reduction was significant in the Impella CP group (VA ECMO 3998.82027.6 mmHg x mL vs VAECMO + Impella 1796.9±1033.9 mmHg x ml, p value 0,016), leading to a more consistent PVA reduction (Impella reduction 34,7% vs PA cannula reduction 9,7%) In terms of end organ perfusion, central and mixed O 2 saturation improved with V-A ECLS, and subsequently, remaining unchanged with either Impella or PA cannula as unloading strategy Conclusions Trans-aortic suction and PA drainage provided effective LV unloading during V-A ECLS while maintaining adequate end-organ perfusion. Trans-aortic suction device provides a greater LV unloading effect and reduces more effectively the total LV stroke work.

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