Management of perioperative low cardiac output state without extracorporeal life support: What is feasible?

AbstractBackground: The aim of this study was to evaluate our experience in central extracorporeal life support with an integrated left ventricular vent in children with cardiac failure. Methods: Eight children acquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n = 4) or during an acute cardiac illness (n = 4). The ascending aorta and right atrium were cannulated. The left ventricular vent was inserted through the right superior pulmonary vein and connected to the venous line on the extracorporeal life support such that active left heart decompression was achieved. Results: No patient died while on support, seven patients were successfully weaned from it and one patient was transitioned to a biventricular assist device. The median length of support was 6 days (range 5–10 days). One patient died while in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombus or embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurological dysfunction during and after extracorporeal life support. Conclusions: In case of a low cardiac output and an insufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heart distension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analyses from the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the left ventricle begins to recover. We recommend the use of central extracorporeal life support with an integrated left ventricular vent in children with intractable cardiac failure.

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Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2012.11.006 ◽

2014 ◽

Vol 147 (1) ◽

pp. 283-289 ◽

Cited By ~ 13

Author(s):

Sung Jun Park ◽

Joon Bum Kim ◽

Sung-Ho Jung ◽

Suk Jung Choo ◽

Cheol Hyun Chung ◽

...

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Life Support ◽

Extracorporeal Life Support ◽

Low Cardiac Output Syndrome ◽

Low Cardiac Output

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Propofol and Fentanyl Anaesthesia for Patients with Low Cardiac Output State Undergoing Cardiac Surgery

Survey of Anesthesiology ◽

10.1097/00132586-199504000-00008 ◽

1995 ◽

Vol 39 (2) ◽

pp. 86

Author(s):

J. BELL ◽

J. SARTAIN ◽

G. A. L. WILKINSON ◽

K. M. SHERRY

Keyword(s):

Cardiac Output ◽

Cardiac Surgery ◽

Low Cardiac Output ◽

Output State

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Cannula position and Bernoulli effect contribute to leg malperfusion during extracorporeal life support with femoral arterial cannulation—an in silico simulation study

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz048 ◽

2019 ◽

Vol 29 (2) ◽

pp. 312-319 ◽

Cited By ~ 2

Author(s):

Markus Bongert ◽

Johannes Gehron ◽

Marius Geller ◽

Andreas Böning ◽

Philippe Grieshaber

Keyword(s):

Cardiac Output ◽

Flow Rate ◽

Femoral Artery ◽

Life Support ◽

Vascular System ◽

Extracorporeal Life Support ◽

Human Aorta ◽

Limb Ischaemia ◽

Artery Cannulation ◽

Cannulation Site

Abstract OBJECTIVES Limb ischaemia during extracorporeal life support (ECLS) using femoral artery cannulation is frequently observed even in patients with regular vessel diameters and without peripheral arterial occlusive disease. We investigated underlying pathomechanisms using a virtual fluid-mechanical simulation of the human circulation. METHODS A life-sized model of the human aorta and major vascular branches was virtualized using 3-dimensional segmentation software (Mimics, Materialise). Steady-state simulation of different grades of cardiac output (0–100%) was performed using Computational Fluid Dynamics (CFX, ANSYS). A straight cannula [virtualized 16 Fr (5.3 mm)] was inserted into the model via the left common femoral artery. The ECLS flow was varied between 1 and 5 l/min. The pressure boundary conditions at the arterial outlets were selected to demonstrate the downstream vascular system. Qualitative and quantitative analyses concerning flow velocity and direction were carried out in various regions of the model. RESULTS During all simulated stages of reduced cardiac output and subsequently adapted ECLS support, retrograde blood flow originating from the ECLS cannula was observed from the cannulation site up to the aortic bifurcation. Analysis of pressure showed induction of zones of negative pressure close to the cannula tip, consistent with the Bernoulli principle. Depending on cannula position and ECLS flow rate, this resulted in negative flow from the ipsilateral superficial femoral artery or the contralateral internal iliac artery. The antegrade flow to the non-cannulated side was generally greater than that to the cannulated side. CONCLUSIONS The cannula position and ECLS flow rate both influence lower limb perfusion during femoral ECLS. Therefore, efforts to optimize the cannula position and to avoid limb malperfusion, including placement of a distal perfusion cannula, should be undertaken in patients treated with ECLS.

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Cardiac tamponade and graft versus host disease: one more reason to remember

Tumori Journal ◽

10.1177/0300891618794890 ◽

2018 ◽

Vol 104 (6) ◽

pp. NP14-NP16 ◽

Cited By ~ 2

Author(s):

Luigi Vetrugno ◽

Serana Tomasino ◽

Alessandra Battezzi ◽

Laura Parisella ◽

Mattia Bernardinetti ◽

...

Keyword(s):

Cardiac Output ◽

Pericardial Effusion ◽

Brain Natriuretic Peptide ◽

Graft Versus Host Disease ◽

Venous Pressure ◽

Central Venous ◽

Low Cardiac Output ◽

Output State ◽

Graft Versus Host ◽

Lactate Levels

Purpose: In patients with cutaneous graft versus host disease (GvHD) that is resistant to traditional steroid therapy, imatinib is a first-generation tyrosine kinase inhibitor that seems to be a viable option. However, its antifibrotic activity can be associated with serosal inflammation and fluid retention. Methods: We report a case of an adult patient who, after allogenic hematopoietic stem cell transplantation, developed a GvHD treated with imatinib at low dosage, followed by multiorgan failure. Clinical examination and cardiac ultrasound were unable to clearly recognize the low cardiac output state; laboratory analysis, filling pressure, and computed tomography examination clarified the correct diagnosis. Results: Low cardiac output state, secondary to pericardial effusion, is a diagnostic challenge. However, the association of four elements can help in its early recognition: increase in lactate levels and central venous pressure, associated with a low central venous saturation and a low brain natriuretic peptide level. Conclusions: Pericardial effusion with cardiac tamponade is a difficult diagnosis even with ultrasound. Lactate levels, central venous pressure plus venous saturation, and brain natriuretic peptide could help in early detection.

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A026 Modulation of renal blood flow by endogenous endothelin-1 in conscious rabbits with low cardiac output state

American Journal of Hypertension ◽

10.1016/s0895-7061(97)90834-7 ◽

1998 ◽

Vol 11 (4) ◽

pp. 37A ◽

Cited By ~ 1

Author(s):

F MUDERS

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Renal Blood Flow ◽

Low Cardiac Output ◽

Output State ◽

Endothelin 1 ◽

Conscious Rabbits

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THE SYSTEMIC AND PULMONARY VASCULAR EFFECTS OF CALCIUM IN THE POST-OP LOW CARDIAC OUTPUT STATE

Anesthesia & Analgesia ◽

10.1213/00000539-198802001-00041 ◽

1988 ◽

Vol 67 (Supplement) ◽

pp. 41 ◽

Cited By ~ 1

Author(s):

R. C. Cork ◽

Joseph A. Gallo ◽

R. Smith ◽

J. Copeland

Keyword(s):

Cardiac Output ◽

Vascular Effects ◽

Low Cardiac Output ◽

Output State

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Low cardiac output state in a postoperative cardiac patient

Challenging Concepts in Paediatric Critical Care ◽

10.1093/med/9780198794592.003.0013 ◽

2020 ◽

pp. 153-166

Author(s):

Arun Ghose ◽

Adrian Plunkett

Keyword(s):

Risk Factors ◽

Cardiac Output ◽

Cardiac Surgery ◽

Measurement Techniques ◽

Surgical Patients ◽

Low Cardiac Output ◽

Output State ◽

Cardiac Lesions ◽

Systolic And Diastolic Function

Chapter 13 covers the low cardiac output state (LCOS) in children following cardiac surgery. It begins by explaining how LCOS is defined, risk factors for its development, and how to assess and investigate a child with LCOS. The role of echocardiography is discussed, and the limitations of other measurement techniques are examined. Modifiable causes of LCOS in postoperative cardiac surgical patients are examined, including residual cardiac lesions and arrhythmias—and their management discussed. Important physiological concepts in the understanding of LCOS are addressed, including preload, afterload, systolic and diastolic function, and fluid responsiveness. Finally, options for managing patients with LCOS are covered, including the role of drugs, surgery, and extracorporeal membrane oxygenation.

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