scholarly journals The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock

2019 ◽  
Vol 7 (11) ◽  
pp. 1768-1773
Author(s):  
Mohamed Abouelwafa ◽  
Waheed Radwan ◽  
Alia Abdelfattah ◽  
Akram Abdelbary ◽  
Mohamed Khaled ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Serum Lactate ◽  
Base Deficit ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Arterial Blood ◽  
Va Ecmo

BACKGROUND: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.AIM: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.MATERIAL AND METHODS: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support. RESULTS: The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005).CONCLUSIONS: We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.

scholarly journals A Long Way Home. Biventricular Impella®, VA-ECMO and Extracorporeal LVAD as Bridge to a Permanent LVAD in Severe Ischemic Cardiogenic Shock: A Case Report

2020 ◽  
Author(s):  
Monika Sadlonova ◽  
Birgit Gerecke ◽  
Aschraf El-Essawi ◽  
Lars-Olav Harnisch ◽  
Onnen Moerer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Team Approach ◽  
Va Ecmo

Abstract Background: A severe cardiogenic shock can present with clinical complications such as arrhythmias, ischemia and organ failure and even today is associated with a high mortality. Extracorporeal life support (ECLS) by veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella® and other mechanical circulatory support systems can reduce the acute circulatory failure. Case presentation: We present the case of a 38-year-old woman with an acute heart failure due to a coronary artery disease who underwent emergency coronary artery bypass grafting and intraoperative implantation of a VA-ECMO. Over the next 4 months, a multidisciplinary team-approach bridged the patient using first a left ventricular (LV) support system (Impella), then additionally a right ventricular (RV) Impella and finally a temporary paracorporeal continuous flow left ventricular support (Rotaflow). Following a promising neurological recovery, a long-term left ventricular assist device (LVAD) was implanted in a bride to transplant (BTT) concept. Conclusions: The addition of LV Impella and RV support by Impella (BiPELLA) on top of VA-ECMO may support survival of patients with refractory cardiogenic shock. In complex biventricular heart failure, an expert center must be able to provide an early multi-modular intervention with elaborated mechanical circulatory support due to a multidisciplinary expertise.

scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Author(s):  
Fernando Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Author(s):  
Fernando Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background: To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®.Methods: Serum lactate and clearance were measured before MCS and at 1h, 6h, 12h, and 24h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality.Results: VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6h, 12h, and 24h after MCS. Serum lactate > 1.55 mmol/L at 24h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67-0.94); positive predictive value = 86%). Failure to improve serum lactate after 24h was associated with 100% mortality.Conclusions: Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24h were the strongest independent predictors of short-term survival.

scholarly journals Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

2021 ◽  
Vol 8 ◽  
Author(s):  
Adamantios Tsangaris ◽  
Tamas Alexy ◽  
Rajat Kalra ◽  
Marinos Kosmopoulos ◽  
Andrea Elliott ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Hospital Admissions ◽  
The United States ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hemodynamic Support ◽  
Membrane Oxygenation ◽  
Va Ecmo

Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.

scholarly journals Multitarget Approach to Cardiogenic Shock after Acute Myocardial Infarction: Extracorporeal Life Support (ECLS) and Beyond

Membranes ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 87
Author(s):  
Federico Pappalardo ◽  
Giulia Malara ◽  
Andrea Montisci
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Systemic Inflammation ◽  
Mechanical Circulatory Support ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Myocardial Revascularization ◽  
Circulatory Support ◽  
Death Spiral

Cardiogenic shock following acute myocardial infarction is associated with high mortality, substantially unchanged for the previous 20 years. Several approaches have been sought to achieve a therapeutic breakthrough, from myocardial revascularization strategies to the use of mechanical circulatory support. Many issues are, as yet, unresolved. Systemic inflammation seems to play a key role but is still lacking in effective therapies, and is potentially compounded by the death spiral of hypoperfusion and/or artificial devices. In this review, a multitarget approach to cardiogenic shock following acute myocardial infarction is proposed.

scholarly journals Association between serum lactate levels and mortality in patients with cardiogenic shock receiving mechanical circulatory support: a multicenter retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fernando Luís Scolari ◽  
Daniel Schneider ◽  
Débora Vacaro Fogazzi ◽  
Miguel Gus ◽  
Marciane Maria Rover ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Prognostic Value ◽  
Mechanical Circulatory Support ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Circulatory Support ◽  
Term Survival ◽  
Time Points ◽  
Lactate Levels ◽  
Va Ecmo

Abstract Background To evaluate the prognostic value of peak serum lactate and lactate clearance at several time points in cardiogenic shock treated with temporary mechanical circulatory support (MCS) using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP®. Methods Serum lactate and clearance were measured before MCS and at 1 h, 6 h, 12 h, and 24 h post-MCS in 43 patients at four tertiary-care centers in Southern Brazil. Prognostic value was assessed by univariable and multivariable analysis and receiver operating characteristic (ROC) curves for 30-day mortality. Results VA-ECMO was the most common MCS modality (58%). Serum lactate levels at all time points and lactate clearance after 6 h were associated with mortality on unadjusted and adjusted analyses. Lactate levels were higher in non-survivors at 6 h, 12 h, and 24 h after MCS. Serum lactate > 1.55 mmol/L at 24 h was the best single prognostic marker of 30-day mortality [area under the ROC curve = 0.81 (0.67–0.94); positive predictive value = 86%). Failure to improve serum lactate after 24 h was associated with 100% mortality. Conclusions Serum lactate was an important prognostic biomarker in cardiogenic shock treated with temporary MCS. Serum lactate and lactate clearance at 24 h were the strongest independent predictors of short-term survival.

Critical Concepts in Extracorporeal Life Support for Cardiogenic Shock

2020 ◽  
pp. 231-240
Author(s):  
Juan C. Diaz Soto ◽  
Justin A. Fried ◽  
A. Reshad Garan
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Aortic Insufficiency ◽  
Fulminant Myocarditis ◽  
Circulatory Support ◽  
Cardiac Transplant ◽  
Ventricular Assist ◽  
Primary Graft Failure ◽  
Va Ecmo

This chapter examines venoarterial extracorporeal membrane oxygenation (VA-ECMO), also known as extracorporeal life support, which is increasingly used to support patients with refractory cardiogenic shock and cardiopulmonary collapse. VA-ECMO is a simplified form of cardiopulmonary bypass which provides both circulatory support and gas exchange. The underlying etiology of the cardiogenic shock is critical to determine the optimal use of this therapy and prognosis. Primary ischemic etiologies such as acute myocardial infarction and non-ischemic etiologies such as fulminant myocarditis, peripartum cardiomyopathy, decompensated pulmonary hypertension, and primary graft failure following cardiac transplant causing cardiogenic shock are frequent indications for VA-ECMO and represent a heterogenous postoperative patient population. However, despite VA-ECMO's broad applicability, a number of contraindications exist: severe, irreversible, non-cardiac organ failure limiting survival; irreversible cardiac failure if transplantation or long-term ventricular assist device will not be considered; severe aortic insufficiency; and aortic dissection. Understanding the potential complications and the hemodynamic consequences of VA-ECMO support is critical to recognize and mitigate some of the risks associated with this therapy and to avoid some common pitfalls with its use. The chapter then looks at the management of patients on VA-ECMO.

scholarly journals Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 747
Author(s):  
Rafal Berger ◽  
Hasan Hamdoun ◽  
Rodrigo Sandoval Boburg ◽  
Medhat Radwan ◽  
Metesh Acharya ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Significant Difference ◽  
Va Ecmo ◽  
Ecmo Therapy

Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.

Abstract 13425: Comparison Between Impella 5.0 and External Corporeal Left Ventricular Assist Device as a Bridge to Decision in Patients With Cardiogenic Shock

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Toru Kondo ◽  
Naoki Shibata ◽  
shingo kazama ◽  
Yuki Kimura ◽  
Hideo Oishi ◽  
...  
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Assist Device ◽  
Ventricular Assist ◽  
Cardiac Recovery ◽  
Left Ventricular Assist ◽  
Bridge To Decision ◽  
Va Ecmo

Background: In cardiogenic shock refractory to medical treatment, choosing and changing mechanical circulatory support to stabilize hemodynamics until cardiac recovery or next treatment is a strategic cornerstone for improving the outcome. We aimed to clarify the differences in treatment course and outcome between Impella 5.0 and extracorporeal left ventricular assist device (eLVAD) in patients with cardiogenic shock refractory to medical therapy or other mechanical circulatory support. Methods: We performed a retrospective medical record review of consecutive patients who were treated with Impella 5.0 or eLVAD as a bridge to decision (BTD) at our medical center from December 2011 to January 2020. Results: A total of 26 patients (median age 40 years, 16 males) were analyzed. Of seven patients managed with Impella 5.0, one patients used Impella CP and four patients used peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) before Impella 5.0 implantation. On the other hand, of 19 patients managed with eLVAD, 11 patients used VA-ECMO before eLVAD implantation. In patients managed with Impella 5.0, Impella 5.0 was removed successfully in two patients (29%) and four patients (71%) underwent the operation for durable LVAD. In patients managed with eLVAD, eLVAD was successfully removed in three patients (16%), nine patients (47%) required durable LVAD, and seven patients (37%) died during eLVAD management. The period between implantation of Impella 5.0 or eLVAD to durable LVAD surgery was significantly shorter with Impella 5.0 (58 [38 - 95] vs. 235 [126 - 318] days, p=0.001). During durable LVAD implantation, cardiopulmonary bypass time was significantly shorter and a significantly smaller amount of red blood cells transfusion was required with Impella 5.0 (149 [125 - 182] vs. 192 [170 - 250] minutes, p=0.042; 7.0 [5.0 - 9.5] vs. 15.0 [10.0- 2.0] units, p=0.019, respectively). There were 4 massive stroke events in eLVAD, but no massive stroke events in Impella 5.0. In Impella 5.0. Conclusions: Impella 5.0 facilitates smoother management as a BTD and reduces surgical invasiveness during durable LVAD implantation. Impella 5.0 would be a more effective option for success to cardiac recovery or next therapy than eLVAD.

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