Evaluate the results of veno-arterial extracorporeal membrane oxygenation for cardiogenic shock patient

Background: Although there are many advances in the diagnosis and resuscitation of patients with cardiogenic shock, the mortality rate is still high, especially for patients with cardiogenic shock due to complications of acute myocardial infarction, the mortality rate can be up to 50 - 70%. Objective: "Evaluate the effectiveness of clinical, subclinical and complications of V-A ECMO in patients with cardiogenic shock". Method: Retrospective analysis of patients diagnosed with cardiogenic shock supported by V-A ECMO revascularization from October 2018 and June 2020; Analyze the significance of V-A ECMO with the clinical outcome prognosis and and complications of V-A ECMO. Results: There were 23 patients hospitalized for cardiogenic shock, they have used the V-A ECMO. The mean age was 53,5±17,6, the minimum age was 13, the oldest was 76. The shortest hospital stay time was 3.5 day and the longest treatment time is 32 days. There were 15 patients alive, accounting for 65.2%, 8 patients died, accounting for 35.8%. The percentage of patients living in the group of myocarditis reached the highest rate. Common complications in patients supported by V-A ECMO are left ventricular volume overload and infection. Conclusion: V-A ECMO is a treatment option for life-threatening cardiogenic shock that has not responded to other therapies.

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Devices for Transcatheter Haemodynamic Support for Left Heart Failure

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.16 ◽

2010 ◽

Vol 5 (1) ◽

pp. 16

Author(s):

Aman Ali ◽

Timothy A Sanborn ◽

◽

Keyword(s):

Mortality Rate ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Assist ◽

Left Heart Failure ◽

Assist Devices ◽

Left Ventricular Assist

Among patients with acute myocardial infarction (AMI), those in cardiogenic shock have the highest mortality rate. Early revascularisation with primary percutaneous intervention or coronary artery bypass surgery has decreased the mortality rate of patients in cardiogenic shock, but it remains high. The conventional treatment of haemodynamic instability has been the use of the intra-aortic balloon pump (IABP); however, the IABP may not give adequate support to patients with severe left ventricular dysfunction. Recent advances in percutaneous left ventricular assist devices, specifically the TandemHeart and Impella LP 2.5, have shown improved haemodynamic support compared with the IABP. This article provides an overview of the use of percutaneous left ventricular assist devices to treat patients presenting with cardiogenic shock after acute MI.

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Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz179 ◽

2019 ◽

Vol 57 (1) ◽

pp. 183-188 ◽

Cited By ~ 6

Author(s):

Charles-Henri David ◽

Astrid Quessard ◽

Ciro Mastroianni ◽

Guillaume Hekimian ◽

Julien Amour ◽

...

Keyword(s):

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Heart Function ◽

Left Ventricular ◽

Survival Outcome ◽

Ventricular Assist Devices ◽

Circulatory Support ◽

Left Ventricular Assist Devices ◽

The Mean ◽

Postcardiotomy Cardiogenic Shock

Abstract OBJECTIVES Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates of 50–80%. Although veno-arterial extracorporeal membrane oxygenation has been used as mechanical circulatory support in patients with PCCS, it is associated with a high rate of complications and poor quality of life. The Impella 5.0 and Impella Left Direct (LD) (Impella 5.0/LD) are minimally invasive left ventricular assist devices that provide effective haemodynamic support resulting in left ventricular unloading and systemic perfusion. Our goal was to describe the outcome of patients with PCCS supported with the Impella 5.0/LD at La Pitié-Salpêtrière Hospital. METHODS We retrospectively reviewed consecutive patients supported with the Impella 5.0/LD for PCCS between December 2010 and June 2015. Survival outcome and in-hospital complications were assessed. RESULTS A total of 29 patients (63 ± 14 years, 17% women) with PCCS were supported with the Impella 5.0/LD. At baseline, 69% experienced chronic heart failure, 66% had dilated cardiomyopathy and 57% had valvular disease. The mean EuroSCORE II was 22 ± 17 and the ejection fraction was 28 ± 11%. Most of the patients underwent isolated valve surgery (45%) or isolated coronary artery bypass grafting (38%). The mean duration of Impella support was 9 ± 7 days. Weaning from the Impella was successful in 72.4%, and 58.6% survived to discharge. Recovery of native heart function was observed in 100% of discharged patients. Survival to 30 days and to 1 year from Impella implant was 58.6% and 51.7%, respectively. CONCLUSIONS The Impella 5.0 and the Impella LD represent an excellent treatment option for critically ill patients with PCCS and are associated with favourable survival outcome and native heart recovery.

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Extracorporeal membrane oxygenation in pheochromocytoma-induced cardiogenic shock

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317727995 ◽

2017 ◽

Vol 26 (4) ◽

pp. 314-316 ◽

Cited By ~ 1

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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A life-threatening reverse Takotsubo syndrome in a young breastfeeding woman: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab359 ◽

2021 ◽

Author(s):

Carla Marques Pires ◽

Sérgia Rocha ◽

Nuno Salomé ◽

Pedro Azevedo

Keyword(s):

Cardiogenic Shock ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Takotsubo Syndrome ◽

Presumptive Diagnosis ◽

Lv Dysfunction ◽

St Segment ◽

Life Threatening ◽

Triggering Factor ◽

Β Blocker

Abstract Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and is usually triggered by emotional, physical or combined stress. This syndrome has been increasingly recognized, although it remains a challenging and often misdiagnosed disorder. Case Summary A 36-year-old breastfeeding woman was admitted with sudden dyspnoea and oppressive chest pain. On admission she was lethargic, hypotensive and tachycardic. The electrocardiogram showed rapid atrial fibrillation and diffuse ST-segment depression. The transthoracic echocardiogram (TTE) revealed severe LV systolic dysfunction, with midventricular and basal akinesis, compensatory apical hyperkinesia and without intraventricular gradient. Emergent coronary angiogram showed normal coronary arteries. A presumptive diagnosis of reverse TTS with cardiogenic shock was made. The patient was transferred to the Intensive Care Unit after intubation and inotropic and vasopressor support was initiated. During hospitalization, rapid clinical improvement was observed. In three days, the patient was weaned from hemodynamic support and extubated. Furthermore, β-blocker and angiotensin receptor blocker were initiated and tolerated. Cabergoline was also administered to inhibit lactation. The presumptive diagnosis was further strengthened by cardiac magnetic resonance and all triggering factors were excluded. At hospital discharge she was asymptomatic and the follow-up TTE was normal, which confirmed the diagnosis of reverse TTS. DISCUSSION We present a case of a young woman, eight months after delivery, which developed a life-threatening reverse TTS without triggering factor identified. Reverse TTS is a rare variant of TTS with different clinical features and is more likely to be complicated by pulmonary edema and cardiogenic shock.

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PILOT RESULTS OF STUDYING CARDIAC MICROPOTENTIALS IN PATIENTS WITH MYOCARDIAL INFARCTION AND CARDIOGENIC SHOCK

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-4-103-110 ◽

2019 ◽

Vol 33 (4) ◽

pp. 103-110 ◽

Cited By ~ 2

Author(s):

I. V. Maximov ◽

D. K. Avdeeva ◽

M. L. Ivanov ◽

I. A. Zimin ◽

M. M. Yuzhakov ◽

...

Keyword(s):

Myocardial Infarction ◽

Pilot Study ◽

High Resolution ◽

Cardiogenic Shock ◽

Myocardial Revascularization ◽

Left Ventricular ◽

National Guidelines ◽

Software Complex ◽

Heart Rhythm Disorders ◽

Life Threatening

Aim. To study cardiac micropotentials registered by the hardware and software complex with nanosensors in patients with myocardial infarction for the early detection of life-threatening conditions.Materials and Methods. The pilot study included 29 patients with acute myocardial infarction who had life-threatening complications such as heart rhythm disorders, the development of acute left ventricular failure, or clinical death prehospitally or at admission to the coronary care unit. The diagnosis of myocardial infarction was established and treatment was carried out according to the national guidelines for the management of patients with myocardial infarction, including the methods of myocardial revascularization.Results. During hospitalization, eight patients developed cardiogenic shock and died. 21 patients survived and were included in the comparison group. At admission, all patients underwent high-resolution electrocardiography using the originally developed hardware and software complex with nanosensors. The micropotentials on the ST segment of the electrocardiogram were recorded for 30 s in three leads on-line. The numbers of micropotentials in the studied groups were analyzed. The analysis of the number of micropotentials within certain ranges of amplitude and duration registered on high-resolution electrocardiogram showed a decrease of the micropotential number in group of patients who died from cardiogenic shock compared with the group of survived patients.Conclusions. The results of this pilot study of cardiac micropotentials are preliminary and require further accumulation of data as well as a search for new criteria for diagnostics, prognosis, and evaluation of the treatment efficacy in patients with myocardial infarction.

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Echocardiographic characterisation of cardiac dilatation induced by volume overload in a canine experimental model

Acta Veterinaria Hungarica ◽

10.1556/avet.55.2007.1.5 ◽

2007 ◽

Vol 55 (1) ◽

pp. 41-50 ◽

Cited By ~ 1

Author(s):

Z. Dudás Györki ◽

A. Kollár ◽

F. Manczur ◽

Violetta Kékesi ◽

K. Vörös

Keyword(s):

Volume Overload ◽

Experimental Period ◽

Ventricular Volume ◽

Pathological Process ◽

Left Ventricular ◽

Canine Heart ◽

Arteriovenous Fistulas ◽

2D Echocardiography ◽

Fractional Shortening ◽

Cardiac Dilatation

The aim of this study was to characterise the development of cardiac dilatation induced by chronic volume overload in 12 dogs. Bilateral arteriovenous fistulas were created between the common femoral arteries and the femoral veins, and the animals were serially studied with transthoracic echocardiography for a period of 12 weeks after the operation. Compared to the measurements obtained before the operation (week 0), the data obtained at the end of the experimental period showed significantly increased left ventricular volume measured by 2D-echocardiography (from 25.1 cm 3 to 43.8 cm 3 , p < 0.0001 in diastole and from 8.6 cm 3 to 16.8 cm 3 , p < 0.001 in systole), and left ventricular diameter measured by M-mode echocardiography (from 26.2 mm to 32.6 mm, p < 0.0001 in diastole and from 17.1 mm to 20.6 mm, p < 0.001 in systole). The size of the left atrium also increased in transversal (from 29.2 mm to 33.6 mm, p < 0.01) but not in longitudinal diameter. In spite of a significant cardiac chamber dilatation over the 12-week period, left ventricular systolic functional variables (fractional shortening, FS % and ejection fraction, EF %), and also the left ventricular systolic and diastolic free wall thickness remained unchanged. In this study we demonstrated that chronic progressive volume overload resulted in gradual dilatation of the canine heart, and that the pathological process can be monitored successfully by serial echocardiography. We found that left atrial dilatation occurred without the development of mitral regurgitation and/or detectable left ventricular dysfunction.

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Ventricular volume overload alters cardiac output distribution in rats during exercise

Journal of Applied Physiology ◽

10.1152/jappl.1980.49.3.482 ◽

1980 ◽

Vol 49 (3) ◽

pp. 482-490 ◽

Cited By ~ 20

Author(s):

S. F. Flaim ◽

W. J. Minteer

Keyword(s):

Skeletal Muscle ◽

Cardiac Output ◽

Left Ventricular Volume ◽

Treadmill Exercise ◽

Volume Overload ◽

Ventricular Volume ◽

Major Effect ◽

Left Ventricular ◽

Radioactive Microsphere ◽

Radioactive Microsphere Technique

A rat model for chronic left ventricular volume overload (a-v fistula, 2 mo) was used to test the effects of acute exhaustive treadmill exercise (EX) (5 min, 70 ft/min, 0 degrees grade) on cardiocirculatory hemodynamics and cardiac output (CO) distribution during heart failure (HF). Control (C) and HF rats were studied at rest (R) and during the last minute of EX. Heart rate (HR), mean arterial pressure (MAP), and left ventricular end-diastolic (LVEDP) pressure were recorded and CO, blood flow (BF) to various regions, and total CO distribution were determined by the radioactive microsphere technique. In HF, biventricular hypertrophy and elevated LVEDP at R were correlated with an average shunt size equaling 37% of total CO. In both groups, CO and HR rose during EX with no change in MAP. Systemic CO in HF was reduced compared to C during both R and EX. BF to splanchnic, renal, cutaneous, and testicular circulations was compromised at R in HF, whereas only skeletal muscle BF was compromised in HF during EX. Data for CO distribution suggest that the major effect of HF during R was increased delivery to the coronary and the skeletal muscle beds at the expense of the cutaneous and renal beds, whereas %CO to the cerebral, hepatic, and gastrointestinal beds was spared. During EX, %CO to skeletal muscle beds in HF was attenuated compared to C, whereas that to the coronary bed was increased with no change in other regions.

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Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock

Perfusion ◽

10.1177/0267659118761558 ◽

2018 ◽

Vol 33 (6) ◽

pp. 493-495 ◽

Cited By ~ 4

Author(s):

Prashant Rao ◽

Jarrod Mosier ◽

Joshua Malo ◽

Vicky Dotson ◽

Christopher Mogan ◽

...

Keyword(s):

Cardiac Arrest ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Mortality Rates ◽

Left Ventricular ◽

Off Pump ◽

Novel Technique ◽

Refractory Cardiogenic Shock ◽

Life Threatening ◽

Va Ecmo

Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.

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