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Al-Kassou B, Theuerkauf N, Nickenig G, Zimmer S. Hemodynamic effects of the combined support with VAV-ECMO, Impella CP, and Impella RP. Clin Res Cardiol 2024; 113:647-650. [PMID: 37728774 PMCID: PMC10954856 DOI: 10.1007/s00392-023-02304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Govender K, Jani VP, Cabrales P. The Disconnect Between Extracorporeal Circulation and the Microcirculation: A Review. ASAIO J 2022; 68:881-889. [PMID: 35067580 DOI: 10.1097/mat.0000000000001618] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal circulation (ECC) procedures, such as cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), take over the function of one or more organs, providing clinicians time to treat underlying pathophysiological conditions. ECMO and CPB carry significant mortality rates for patients, despite prior decades of research focused on the resulting failure of critical organs. Since the focus of these procedures is to support blood flow and provide oxygen-rich blood to tissues, a shift in research toward the effects of ECMO and CPB on the microcirculation is warranted. Along with provoking systemic responses, both procedures disrupt the integrity of red blood cells, causing release of hemoglobin (Hb) from excessive foreign surface contact and mechanical stresses. The effects of hemolysis are especially pronounced in the microcirculation, where plasma Hb leads to nitric oxide scavenging, oxidization, formation of reactive oxygen species, and inflammatory responses. A limited number of studies have investigated the implications of ECMO in the microcirculation, but more work is needed to minimize ECMO-induced reduction of microcirculatory perfusion and consequently oxygenation. The following review presents existing information on the implications of ECMO and CPB on microvascular function and proposes future studies to understand and leverage key mechanisms to improve patient outcomes.
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Affiliation(s)
- Krianthan Govender
- From the Functional Cardiovascular Engineering Laboratory, University of California, San Diego, La Jolla, California
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Perioperative Management of Patients Receiving Short-term Mechanical Circulatory Support with the Transvalvular Heart Pump. Anesthesiology 2022; 136:829-842. [PMID: 35120198 DOI: 10.1097/aln.0000000000004124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Use of the transvalvular heart pump to provide short-term circulatory support in the perioperative setting is growing. The considerations for the perioperative management of patients receiving transvalvular heart pump support are reviewed for the anesthesiologist.
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Iannaccone M, Venuti G, di Simone E, De Filippo O, Bertaina M, Colangelo S, Boccuzzi G, de Piero ME, Attisani M, Barbero U, Zanini P, Livigni S, Noussan P, D'Ascenzo F, de Ferrari GM, Porto I, Truesdell AG. Comparison of ECMO vs ECpella in patients with non post-pericardiotomy cardiogenic shock: An updated meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:134-141. [PMID: 34654655 DOI: 10.1016/j.carrev.2021.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS. METHODS All studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes. RESULTS Of 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6-59.9) in the VA-ECMO group and 58.3% (53.5-63.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9-26.5) and 33.1% (25.9-41.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0-22.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039-3.159). CONCLUSION Our data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates.
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Affiliation(s)
- Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
| | | | - Emanuela di Simone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | - Maurizio Bertaina
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Salvatore Colangelo
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Giacomo Boccuzzi
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Maria Elena de Piero
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Matteo Attisani
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Paola Zanini
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Sergio Livigni
- Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Patrizia Noussan
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy
| | | | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
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