scholarly journals Nephrology considerations in the management of durable and temporary mechanical circulatory support

Kidney360 ◽  
2022 ◽  
pp. 10.34067/KID.0003382021
Author(s):  
Carl P. Walther ◽  
Andrew B. Civitello ◽  
Kenneth K. Liao ◽  
Sankar D. Navaneethan
Keyword(s):  
Mechanical Circulatory Support ◽  
Current Knowledge ◽  
Acute Decompensated Heart Failure ◽  
Complex Structure ◽  
Axial Flow ◽  
Circulatory Support ◽  
Kidney Dysfunction ◽  
Health States ◽  
Health Function ◽  
Kidney Health

Durable and temporary mechanical circulatory support (MCS) use is growing for a range of cardiovascular indications. Kidney dysfunction is common in persons evaluated for or receiving durable or temporary MCS, and portends worse outcomes. This kidney dysfunction can be due to pre-existing kidney chronic kidney disease (CKD), acute kidney injury (AKI) related to acute cardiovascular disease necessitating MCS, AKI due to cardiac procedures, and due to acute and chronic MCS effects and complications. Durable MCS, with implantable continuous flow pumps, is used for long-term support in advanced HF refractory to guideline directed medical and device therapy, either permanently or as a bridge to heart transplantation. Temporary MCS-encompassing in this review intra-aortic balloon pumps (IABPs), axial flow pumps, centrifugal flow pumps, and venoarterial ECMO-is used for diverse situations: high risk percutaneous coronary interventions (PCI), acute decompensated heart failure (HF), cardiogenic shock, and resuscitation following cardiac arrest. The wide adoption of MCS makes it imperative to improve understanding of the effects of MCS on kidney health/function, and of kidney health/function on MCS outcomes. The complex structure and functions of the kidney, and the complex health states of individuals receiving MCS, makes investigations in this area challenging, and current knowledge is limited. Fortunately, the increasing nephrology toolbox of non-invasive kidney health/function assessments may enable development and testing of individualized management strategies and therapeutics in the future. We review technology, epidemiology, pathophysiology, clinical considerations, and future directions in MCS and nephrology.

scholarly journals Mechanical circulatory support in refractory cardiogenic shock due to influenza virus-related myocarditis

2020 ◽  
Vol 56 (3) ◽  
pp. 2000925 ◽  
Author(s):  
Jan-Thorben Sieweke ◽  
Muharrem Akin ◽  
Sebastian Stetskamp ◽  
Christian Riehle ◽  
Danny Jonigk ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Influenza Virus Infection ◽  
Axial Flow ◽  
Circulatory Support ◽  
Influenza B ◽  
Refractory Cardiogenic Shock ◽  
Va Ecmo ◽  
The Impact

BackgroundThere is scarce evidence for mechanical circulatory support (MCS) in patients with influenza-related myocarditis complicated by refractory cardiogenic shock (rCS). We sought to investigate the impact of MCS using combined veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and micro-axial flow pumps (the ECMELLA concept) in influenza-related myocarditis complicated by rCS.MethodsThis is a prospective, observational analysis from the single centre HAnnover Cardiac Unloading REgistry (HACURE) from two recent epidemic influenza seasons. We analysed patients with verified influenza-associated myocarditis complicated by rCS who were admitted to our intensive care unit (ICU) on MCS. Subsequently, we performed a propensity score (PS) matched analysis to patients with acute myocardial infarction (AMI) complicated by rCS and non-ischaemic cardiomyopathy (DCM) related rCS.ResultsWe describe a series of seven patients with rCS-complicated influenza-related myocarditis (mean age 56±10 years, 58% male, influenza A (n=2)/influenza B (n=5)). No patient had been vaccinated prior to the influenza season. MCS was provided using combined VA-ECMO and Impella micro-axial flow pump. In two patients with out-of-hospital cardiac arrest, VA-ECMO had been implanted for extracorporeal cardiopulmonary resuscitation. All patients died within 18 days of hospital admission. By PS-based comparison to patients with AMI- or DCM-related rCS and combined MCS, 30-day mortality was significantly higher in influenza-related rCS.ConclusionDespite initial stabilisation with combined MCS in patients with rCS-complicated influenza-related myocarditis, the detrimental course of shock could not be stopped and all patients died. Influenza virus infection potentially critically affects other organs besides the heart, leading to irreversible end-organ damage that MCS cannot compensate for and, therefore, results in a devastating outcome.

scholarly journals Cardiogenic shock complicating peripartum cardiomyopathy: Importance of early left ventricular unloading and bromocriptine therapy

2018 ◽  
Vol 9 (2) ◽  
pp. 173-182 ◽  
Author(s):  
Jan-Thorben Sieweke ◽  
Tobias Jonathan Pfeffer ◽  
Dominik Berliner ◽  
Tobias König ◽  
Maximiliane Hallbaum ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Axial Flow ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Left Ventricular Recovery

Introduction: Acute peripartum cardiomyopathy complicated by cardiogenic shock is a rare but life-threatening disease. A prolactin fragment is considered causal for the pathogenesis of peripartum cardiomyopathy. This analysis sought to investigate the role of early percutaneous mechanical circulatory support with micro-axial flow-pumps and/or veno-arterial extracorporeal membrane oxygenation in combination with the prolactin inhibitor bromocriptine in refractory cardiogenic shock complicating peripartum cardiomyopathy. Methods and results: In this single-centre analysis, five peripartum cardiomyopathy patients with refractory cardiogenic shock received mechanical circulatory support with either Impella CP microaxial pump only ( n=2) or in combination with veno-arterial extracorporeal membrane oxygenation ( n=3) in the setting of biventricular failure. All patients were mechanically ventilated. In all cases mechanical circulatory support was combined with bromocriptine therapy and early administration of levosimendan. All patients survived the acute phase of refractory cardiogenic shock. Mechanical circulatory support using a micro-axial pump allowed to significantly reduce catecholamine dosage. Remarkably, early left ventricular support with micro-axial flow-pumps resulted in myocardial recovery whereas delayed Impella (mechanical circulatory support) implantation was associated with poor left ventricular recovery. Conclusion: Mechanical circulatory support in patients with refractory cardiogenic shock complicating peripartum cardiomyopathy was associated with a 30-day survival of 100% and a favourable outcome. Notably, early left ventricular unloading combined with bromocriptine therapy was associated with left ventricular recovery. Therefore, an immediate transfer to a tertiary hospital experienced in mechanical circulatory support in combination with bromocriptine treatment seems indispensable for successful treatment of peripartum cardiomyopathy complicated by cardiogenic shock.

scholarly journals Implementation of a Cardiogenic Shock Team and Clinical Outcomes (INOVA-SHOCK Registry): Observational and Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Behnam Tehrani ◽  
Alexander Truesdell ◽  
Ramesh Singh ◽  
Charles Murphy ◽  
Patricia Saulino
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Clinical Outcomes ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Survival Rates ◽  
Decompensated Heart Failure ◽  
Circulatory Support

BACKGROUND The development and implementation of a Cardiogenic Shock initiative focused on increased disease awareness, early multidisciplinary team activation, rapid initiation of mechanical circulatory support, and hemodynamic-guided management and improvement of outcomes in cardiogenic shock. OBJECTIVE The objectives of this study are (1) to collect retrospective clinical outcomes for acute decompensated heart failure cardiogenic shock and acute myocardial infarction cardiogenic shock, and compare current versus historical survival rates and clinical outcomes; (2) to evaluate Inova Heart and Vascular Institute site specific outcomes before and after initiation of the Cardiogenic Shock team on January 1, 2017; (3) to compare outcomes related to early implementation of mechanical circulatory support and hemodynamic-guided management versus historical controls; (4) to assess survival to discharge rate in patients receiving intervention from the designated shock team and (5) create a clinical archive of Cardiogenic Shock patient characteristics for future analysis and the support of translational research studies. METHODS This is an observational, retrospective, single center study. Retrospective and prospective data will be collected in patients treated at the Inova Heart and Vascular Institute with documented cardiogenic shock as a result of acute decompensated heart failure or acute myocardial infarction. This registry will include data from patients prior to and after the initiation of the multidisciplinary Cardiogenic Shock team on January 1, 2017. Clinical outcomes associated with early multidisciplinary team intervention will be analyzed. In the study group, all patients evaluated for documented cardiogenic shock (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) treated at the Inova Heart and Vascular Institute by the Cardiogenic Shock team will be included. An additional historical Inova Heart and Vascular Institute control group will be analyzed as a comparator. Means with standard deviations will be reported for outcomes. For categorical variables, frequencies and percentages will be presented. For continuous variables, the number of subjects, mean, standard deviation, minimum, 25th percentile, median, 75th percentile and maximum will be reported. Reported differences will include standard errors and 95% CI. RESULTS Preliminary data analysis for the year 2017 has been completed. Compared to a baseline 2016 survival rate of 47.0%, from 2017 to 2018, CS survival rates were increased to 57.9% (58/110) and 81.3% (81/140), respectively (P=.01 for both). Study data will continue to be collected until December 31, 2018. CONCLUSIONS The preliminary results of this study demonstrate that the INOVA SHOCK team approach to the treatment of Cardiogenic Shock with early team activation, rapid initiation of mechanical circulatory support, hemodynamic-guided management, and strict protocol adherence is associated with superior clinical outcomes: survival to discharge and overall survival when compared to 2015 and 2016 outcomes prior to Shock team initiation. What may limit the generalization of these results of this study to other populations are site specific; expertise of the team, strict algorithm adherence based on the INOVA SHOCK protocol, and staff commitment to timely team activation. Retrospective clinical outcomes (acute decompensated heart failure cardiogenic shock, acute myocardial infarction cardiogenic shock) demonstrated an increase in current survival rates when compared to pre-Cardiogenic Shock team initiation, rapid team activation and diagnosis and timely utilization of mechanical circulatory support. CLINICALTRIAL ClinicalTrials.gov NCT03378739; https://clinicaltrials.gov/ct2/show/NCT03378739 (Archived by WebCite at http://www.webcitation.org/701vstDGd)

Mechanical Circulatory Support of a Univentricular Fontan Circulation with a Continuous Axial-Flow Pump in a Piglet Model

ASAIO Journal ◽  
2015 ◽  
Vol 61 (2) ◽  
pp. 196-201 ◽  
Author(s):  
Xufeng Wei ◽  
Pablo G. Sanchez ◽  
Yang Liu ◽  
Tieluo Li ◽  
A. Claire Watkins ◽  
...  
Keyword(s):  
Mechanical Circulatory Support ◽  
Axial Flow ◽  
Fontan Circulation ◽  
Circulatory Support ◽  
Axial Flow Pump ◽  
Flow Pump

scholarly journals Levosimendan Plus Dobutamine in Acute Decompensated Heart Failure Refractory to Dobutamine

2020 ◽  
Vol 9 (11) ◽  
pp. 3605
Author(s):  
William Juguet ◽  
Damien Fard ◽  
Laureline Faivre ◽  
Athanasios Koutsoukis ◽  
Camille Deguillard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Superior Vena ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Major Cardiovascular Events ◽  
Single Center Study

Randomized studies showed that Dobutamine and Levosimendan have similar impact on outcome but their combination has never been assessed in acute decompensated heart failure (ADHF) with low cardiac output. This is a retrospective, single-center study that included 89 patients (61 ± 15 years) admitted for ADHF requiring inotropic support. The first group consisted of patients treated with dobutamine alone (n = 42). In the second group, levosimendan was administered on top of dobutamine, when the superior vena cava oxygen saturation (ScVO2) remained <60% after 3 days of dobutamine treatment (n = 47). The primary outcome was the occurrence of major cardiovascular events (MACE) at 6 months, defined as all cause death, heart transplantation or need for mechanical circulatory support. Baseline clinical characteristics were similar in both groups. At day-3, the ScVO2 target (>60%) was reached in 36% and 32% of patients in the dobutamine and dobutamine-levosimendan group, respectively. After adding levosimendan, 72% of the dobutamine-levosimendan-group reached the ScVO2 target value at dobutamine weaning. At six months, 42 (47%) patients experienced MACE (n = 29 for death). MACE was less frequent in the dobutamine-levosimendan (32%) than in the dobutamine-group (64%, p = 0.003). Independent variables associated with outcome were admission systolic blood pressure and dobutamine-levosimendan strategy (OR = 0.44 (0.23–0.84), p = 0.01). In conclusion, levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone.

scholarly journals Inotropes Are Linked to Increased Mortality in Heart Failure

2015 ◽  
Author(s):  
M Chadi Alraies ◽  
Bill Tran ◽  
Sirtaz Adatya
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Supplemental Oxygen ◽  
Circulatory Support ◽  
Organ Perfusion ◽  
The Usa ◽  
End Stage

With the advancement of technology and availability of mechanical circulatory support (MCS) devices for the treatment of acute decompensated systolic HF in the 21st century, the role of inotropes is becoming obsolete. Medical therapy for acute decompensated heart failure (HF) has not changed since 1960’s, we still use supplemental oxygen, diuretics, vasodilators and inotropes to improve congestion, cardiac output, end organ perfusion and symptoms related to elevate filling pressures1 . Despite demonstrated improvements in hemodynamics, the uses of inotropes have not demonstrated any improvements in mortality. Mechanical circulatory support (MCS) use is growing rapidly in the USA, in patients with stage D HF both as destination therapy and as a bridge to cardiac transplantation. In both, transplant-eligible and non-transplant-eligible patients, improvement in end-organ perfusion, functional capacity, quality of life and most importantly mortality have been demonstrated. In this perspective paper we are going to discuss the current lack of evidence for inotropic therapy and the evolving benefit of MCS in end-stage systolic HF patients.

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