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Hashmani S, Manla Y, Al Matrooshi N, Bader F. Red Flags in Acute Myocarditis. Card Fail Rev 2024; 10:e02. [PMID: 38464556 PMCID: PMC10918526 DOI: 10.15420/cfr.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/02/2023] [Indexed: 03/12/2024] Open
Abstract
Acute myocarditis is an inflammatory disease of the heart that may occur in the setting of infection, immune system activation or exposure to certain drugs. Often, it is caused by viruses, whereby the clinical course is usually benign; however, it may also present with rapidly progressive fulminant myocarditis, which is associated with high morbidity and mortality. This review highlights the critical red flags - from the clinical, biochemical, imaging and histopathological perspectives - that should raise the index of suspicion of acute myocarditis. We also present an illustrative case of a young female patient with rapidly progressive cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation as a bridge to orthotopic heart transplantation. The patient showed no clinical or echocardiographic recovery signs and eventually underwent orthotopic heart transplantation. Furthermore, we elaborate on the classifications of acute myocarditis based on clinical presentation and histopathology classifications, focusing on identifying key red flags that will inform early diagnosis and appropriate management in such challenging cases.
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Affiliation(s)
- Shahrukh Hashmani
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Yosef Manla
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Nadya Al Matrooshi
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Feras Bader
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
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2
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Komatsu M, Naito K, Chino S, Tanaka H, Ichimura H, Yamamoto T, Nakahara K, Fuke M, Wada Y, Seto T. Central extracorporeal membrane oxygenation with left-ventricular vent for fulminant myocarditis: a retrospective study. J Artif Organs 2023; 26:297-302. [PMID: 36348184 DOI: 10.1007/s10047-022-01371-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Fulminant myocarditis presents as acute severe heart failure and requires mechanical cardiocirculatory support. Left-ventricular (LV) decompression is necessary for the successful recovery of these patients. This retrospective study aimed to evaluate the functional outcomes of providing central extracorporeal membrane oxygenation (ECMO) with LV decompression for the treatment of refractory fulminant myocarditis. METHODS Between January 2015 and February 2021, seven consecutive fulminant myocarditis patients (mean age: 41.1 ± 26.1 years) received central ECMO support with transapical LV decompression, with an 18 French cannula integrated into the ECMO circuit in a Y-fashion. The baseline characteristics and postoperative outcomes of the patients were collected. RESULTS On admission, all patients received prior peripheral ECMO, and 85.7% (6/7) of patients received prior intra-aortic balloon pumping. However, all patients had refractory cardiogenic shock that failed prior to decompression. Six patients recovered successfully after a mean ECMO support of 20.0 ± 11.5 days and five patients had no recurrence of cardiac decompensation. The mean ICU and mean hospital stays were 36.7 ± 23.5 days and 60.6 ± 24.9 days, respectively. Hospital mortality was 28.6% (2/7). Two patients died due to sepsis and stroke during hospitalization. CONCLUSIONS Central ECMO with an LV vent was effective for fulminant myocarditis refractory to percutaneous cardiopulmonary support therapy and other therapies.
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Affiliation(s)
- Masaki Komatsu
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Kazuki Naito
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Shuji Chino
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Haruki Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Hajime Ichimura
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Takateru Yamamoto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Ko Nakahara
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Megumi Fuke
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsuichiro Seto
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano, 390-8621, Japan.
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3
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Akutsu T, Endo A, Sonobe H, Suzuki K, Murata K, Otomo Y. A case of fulminant myocarditis with full recovery after a 38-h sustained asystole. Clin Case Rep 2023; 11:e7722. [PMID: 37529125 PMCID: PMC10387519 DOI: 10.1002/ccr3.7722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 08/03/2023] Open
Abstract
Key Clinical Message Even if cardiac rhythm deteriorated to asystole in the clinical course of fulminant myocarditis, cardiac function may recover, and the patient may be discharged without brain damage, if circulation could be maintained by appropriate mechanical cardiac supports. Abstract A 69-year-old man was diagnosed with fulminant myocarditis with circulatory collapse. His cardiac rhythm deteriorated to asystole on the second day; however, circulatory status was maintained through extracorporeal membrane oxygenation and intra-aortic balloon pumping. After 38 h-lasting asystole, his heart resumed beating. He was discharged without neurological deficits on Day 25.
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Affiliation(s)
- Tomohiro Akutsu
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Akira Endo
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of MedicineBunkyo‐kuJapan
| | - Hiroyuki Sonobe
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Keisuke Suzuki
- Department of Acute Critical Care MedicineTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Kiyoshi Murata
- Department of Acute Critical Care MedicineMatsudo General HospitalMatsudoJapan
| | - Yasuhiro Otomo
- Department of Acute Critical Care and Disaster MedicineTokyo Medical and Dental University Graduate School of MedicineBunkyo‐kuJapan
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Giordani AS, Baritussio A, Vicenzetto C, Peloso-Cattini MG, Pontara E, Bison E, Fraccaro C, Basso C, Iliceto S, Marcolongo R, Caforio ALP. Fulminant Myocarditis: When One Size Does Not Fit All - A Critical Review of the Literature. Eur Cardiol 2023; 18:e15. [PMID: 37405349 PMCID: PMC10316338 DOI: 10.15420/ecr.2022.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 07/06/2023] Open
Abstract
Fulminant myocarditis, rather than being a distinct form of myocarditis, is instead a peculiar clinical presentation of the disease. The definition of fulminant myocarditis has varied greatly in the last 20 years, leading to conflicting reports on prognosis and treatment strategies, mainly because of varied inclusion criteria in different studies. The main conclusion of this review is that fulminant myocarditis may be due to different histotypes and aetiologies that can be diagnosed only by endomyocardial biopsy and managed by aetiology-directed treatment. This life-threatening presentation requires rapid, targeted management both in the short term (mechanical circulatory support, inotropic and antiarrhythmic treatment and endomyocardial biopsy) and in the long term (including prolonged follow-up). Fulminant presentation has also recently been identified as a risk factor for worsened prognosis, even long after the resolution of the acute phase of myocarditis.
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Affiliation(s)
- Andrea Silvio Giordani
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Anna Baritussio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Vicenzetto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Maria Grazia Peloso-Cattini
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elena Pontara
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Elisa Bison
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Chiara Fraccaro
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Renzo Marcolongo
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
| | - Alida Linda Patrizia Caforio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua and Azienda Ospedale Università di PadovaPadua, Italy
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Vishram-Nielsen JKK, Foroutan F, Rizwan S, Peck SS, Bodack J, Orchanian-Cheff A, Gustafsson F, Ross HJ, Fan E, Rao V, Billia F, Alba AC. Patients with fulminant myocarditis supported with veno-arterial extracorporeal membrane oxygenation: a systematic review and meta-analysis of short-term mortality and impact of risk factors. Heart Fail Rev 2023; 28:347-357. [PMID: 36205853 PMCID: PMC9540286 DOI: 10.1007/s10741-022-10277-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 11/04/2022]
Abstract
Fulminant myocarditis (FM) may lead to cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Results of effectiveness studies of VA-ECMO have been contradictory. We evaluated the aggregate short-term mortality after VA-ECMO and predictive factors in patients with FM. We systematically searched in electronic databases (February 2022) to identify studies evaluating short-term mortality (defined as mortality at 30 days or in-hospital) after VA-ECMO support for FM. We included studies with 5 or more patients published after 2009. We assessed the quality of the evidence using the QUIPS and GRADE tools. Mortality was pooled using random effect models. We performed meta-regression to explore heterogeneity based on a priori defined factors. We included 54 observational studies encompassing 2388 FM patients supported with VA-ECMO. Median age was 41 years (25th to 75th percentile 37-47), and 50% were female. The pooled short-term mortality was 35% (95% CI 29-40%, I2 = 69%; moderate certainty). By meta-regression, studies with younger populations showed lower mortality. Female sex, receiving a biopsy, cardiac arrest, left ventricular unloading, and earlier recruitment time frame, did not explain heterogeneity. These results remained consistent regardless of continent and the risk of bias category. In individual studies, low pH value, high lactate, absence of functional cardiac recovery on ECMO, increased burden of malignant arrhythmia, high peak coronary markers, and IVIG use were identified as independent predictors of mortality. When conventional therapies have failed, especially in younger patients, cardiopulmonary support with VA-ECMO should be considered in the treatment of severe FM.
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Affiliation(s)
- Julie K. K. Vishram-Nielsen
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada ,grid.4973.90000 0004 0646 7373Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Farid Foroutan
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Saima Rizwan
- grid.416166.20000 0004 0473 9881Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON Canada
| | - Serena S. Peck
- grid.17063.330000 0001 2157 2938Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Julia Bodack
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Ani Orchanian-Cheff
- grid.231844.80000 0004 0474 0428Library and Information Services, University Health Network, Toronto, ON Canada
| | - Finn Gustafsson
- grid.4973.90000 0004 0646 7373Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Heather J. Ross
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Eddy Fan
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Vivek Rao
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Filio Billia
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
| | - Ana Carolina Alba
- grid.231844.80000 0004 0474 0428Heart Failure and Transplant Program, Peter Munk Cardiac Centre, University Health Network, Toronto, ON Canada
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6
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Central extracorporeal membrane oxygenation with left-ventricular vent for fulminant myocarditis: a retrospective study. J Artif Organs 2022. [DOI: 10.1007/s10047-022-01371-y 10.1007/s10047-022-01371-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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7
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Haroun MW, Patel SR, Sims D, Jorde UP, Goldstein DJ, Saeed O. Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2022; 36:2935-2941. [PMID: 35249832 PMCID: PMC8815267 DOI: 10.1053/j.jvca.2022.01.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 01/08/2023]
Abstract
Objectives Cardiac injury has been reported in up to 20%-to-30% of patients with COVID-19, and severe disease can lead to cardiopulmonary failure. The role of mechanical circulatory support in these patients remains undetermined. The authors here aimed to determine the characteristics and outcomes of patients with COVID-19 requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or veno-arterial-venous (VAV) ECMO support. Design and Setting A multicenter, retrospective case series. Participants The cohort consisted of adult patients (18 years of age and older) with confirmed COVID-19 requiring VA ECMO or VAV ECMO support in the period from March 1, 2020, to April 30, 2021. Outcomes were recorded until July 31, 2021. Measurements and Main Results To show factors related to death during hospitalization, patients were grouped as survivors and nonsurvivors. Kaplan-Meier analysis was used to estimate 90-day in-hospital mortality. Overall, 37 patients from 12 centers comprised the study cohort. The median patient age was 44 years old (interquartile range [IQR], 35-52), and 12 (32%) were female patients. The duration of ECMO support ranged from 2-to-132 days. At the end of the follow-up period, 13 patients (35%) were discharged or transferred alive, and 24 patients (65%) died during the hospitalization. The cumulative in-hospital mortality at 90 days was 64% (95% confidence interval: 47-81). During the time from intubation to VA ECMO or VAV ECMO initiation (1 day [IQR 0-7.5] v 6 days [IQR 2.5-14], p = 0.0383), body mass index (32 [IQR 26-36] v 37 [IQR 33-40], p = 0.009), and baseline C-reactive protein (7.15 v 38.9 mg/dL, p = 0.009) were higher in those who expired. Conclusion Only one-third of the patients with COVID-19 requiring VA ECMO or VAV ECMO survived to discharge. Close monitoring of at-risk patients with early initiation of ECMO with circulatory support may further improve outcomes.
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Ho ST, Yeh TC, Chang HH, Wang JO, Kao S, Lin TC. Age and comorbidities as predictors of hospital mortality in adult patients who receive extracorporeal membrane oxygenation therapy: A population-based study. JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.4103/jmedsci.jmedsci_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elliott A, Dahyia G, Kalra R, Alexy T, Bartos J, Kosmopoulos M, Yannopoulos D. Extracorporeal Life Support for Cardiac Arrest and Cardiogenic Shock. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The rising incidence and recognition of cardiogenic shock has led to an increase in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). As clinical experience with this therapy has increased, there has also been a rapid growth in the body of observational and randomized data describing the clinical and logistical considerations required to institute a VA-ECMO program with successful clinical outcomes. The aim of this review is to summarize this contemporary data in the context of four key themes that pertain to VA-ECMO programs: the principles of patient selection; basic hemodynamic and technical principles underlying VA-ECMO; contraindications to VA-ECMO therapy; and common complications and intensive care considerations that are encountered in the setting of VA-ECMO therapy.
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Affiliation(s)
- Andrea Elliott
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Garima Dahyia
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Rajat Kalra
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Jason Bartos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Marinos Kosmopoulos
- Department of Medicine, Division of Cardiology, Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN
| | - Demetri Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN
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Loforte A, Comentale G, Botta L, Gliozzi G, Cavalli GG, Mariani C, Pilato E, Suarez SM, Pacini D. How Would the Authors Treat Their Own Temporary Left Ventricular Failure With Mechanical Circulatory Support? J Cardiothorac Vasc Anesth 2021; 36:1238-1250. [PMID: 34785126 DOI: 10.1053/j.jvca.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/23/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022]
Abstract
In the last 20 years, mechanical circulatory supports (MCS) have overturned completely the outcomes and the clinical recovery of patients with isolated acute left ventricle failure (iALVF). This usually occurs more frequently than right-sided heart failure or biventricular dysfunction, and it mainly is caused by acute myocardial infarction. The primary role of MCS is to restore the tissue metabolism to preserve the vital organs' function but, on the other hand, they also have to relieve the workload stress on the heart. In this way, they allow not only the heart to recover from the acute event, but MCS also can stabilize the patient toward cardiac transplantation. The short-term MCS devices currently used in clinical practice are the intraaortic balloon pump, the Impella (Abiomed, Danvers, MA), and venoarterial extracorporeal membrane oxygenation (VA-ECMO), but the choice of the right and tailored device for each patient, as well as the timing to use it, is actually one of the most debated topics of MCS management.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy.
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy; Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Luca Botta
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlo Mariani
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Sofia Martin Suarez
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
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Tsangaris A, Alexy T, Kalra R, Kosmopoulos M, Elliott A, Bartos JA, Yannopoulos D. Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock. Front Cardiovasc Med 2021; 8:686558. [PMID: 34307500 PMCID: PMC8292640 DOI: 10.3389/fcvm.2021.686558] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Marinos Kosmopoulos
- Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Andrea Elliott
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.,Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States.,Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
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Makhoul M, Heuts S, Mansouri A, Taccone FS, Obeid A, Mirko B, Broman LM, Malfertheiner MV, Meani P, Raffa GM, Delnoij T, Maessen J, Bolotin G, Lorusso R. Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death. Artif Organs 2021; 45:1155-1167. [PMID: 34101843 PMCID: PMC8518076 DOI: 10.1111/aor.14006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 05/08/2021] [Accepted: 06/01/2021] [Indexed: 11/28/2022]
Abstract
Timing and causes of hospital mortality in adult patients undergoing veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) have been poorly described. Aim of the current review was to investigate the timing and causes of death of adult patients supported with V‐A ECMO and subsequently define the “V‐A ECMO gap,” which represents the patients who are successfully weaned of ECMO but eventually die during hospital stay. A systematic search was performed using electronic MEDLINE and EMBASE databases through PubMed. Studies reporting on adult V‐A ECMO patients from January 1993 to December 2020 were screened. The studies included in this review were studies that reported more than 10 adult, human patients, and no mechanical circulatory support other than V‐A ECMO. Information extracted from each study included mainly mortality and causes of death on ECMO and after weaning. Complications and discharge rates were also extracted. Sixty studies with 9181 patients were included for analysis in this systematic review. Overall mortality was 38.0% (95% confidence intervals [CIs] 34.2%‐41.9%) during V‐A ECMO support (reported by 60 studies) and 15.3% (95% CI 11.1%‐19.5%, reported by 57 studies) after weaning. Finally, 44.0% of patients (95% CI 39.8‐52.2) were discharged from hospital (reported by 60 studies). Most common causes of death on ECMO were multiple organ failure, followed by cardiac failure and neurological causes. More than one‐third of V‐A ECMO patients die during ECMO support. Additionally, many of successfully weaned patients still decease during hospital stay, defining the “V‐A ECMO gap.” Underreporting and lack of uniformity in reporting of important parameters remains problematic in ECMO research. Future studies should uniformly define timing and causes of death in V‐A ECMO patients to better understand the effectiveness and complications of this support.
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Affiliation(s)
- Maged Makhoul
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Abdulrahman Mansouri
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Fabio Silvio Taccone
- Department of Intensive Care Medicine, Clinique Universitaire de Bruxelles (CUB) Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Amir Obeid
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Belliato Mirko
- U.O.C. Anestesia e Rianimazione II Cardiopolmonare, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Paolo Meani
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Giuseppe Maria Raffa
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Thijs Delnoij
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.,Intensive Care Department, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Gil Bolotin
- Cardiac Surgery Unit, Rambam Medical Centre, Haifa, Israel
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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13
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The use of extracorporeal membrane oxygenation in the treatment of fulminant myocarditis: Current progress and clinical outcomes. Microvasc Res 2021; 137:104190. [PMID: 34048806 DOI: 10.1016/j.mvr.2021.104190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 11/21/2022]
Abstract
Myocarditis is an inflammatory condition of the myocardium and is usually categorised as acute nonfulminant and acute fulminant myocarditis. Myocardial injury can result via viral infections, direct injury or immune responses. Fulminant myocarditis can be characterised by severe and sudden cardiac inflammation that may result from cardiogenic shock, ventricular arrhythmias or multi-organ system failure. Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is an effective technique for patients with fulminant myocarditis, providing heart and lung support and adequate gas exchange or perfusion to sustain life. Essentially, ECMO pumps blood out of the body to an oxygenator that acts as an artificial lung, which adds oxygen to the blood and removes carbon dioxide. This report aims to review recent advances in ECMO and relate case studies of fulminant myocarditis patients. The types of ECMO, predictive factors for success, clinical studies and recent technological advances in the field will be discussed.
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14
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Alba AC, Foroutan F, Buchan TA, Alvarez J, Kinsella A, Clark K, Zhu A, Lau K, McGuinty C, Aleksova N, Francis T, Stanimirovic A, Vishram-Nielsen J, Malik A, Ross HJ, Fan E, Rac VE, Rao V, Billia F. Mortality in patients with cardiogenic shock supported with VA ECMO: A systematic review and meta-analysis evaluating the impact of etiology on 29,289 patients. J Heart Lung Transplant 2021; 40:260-268. [DOI: 10.1016/j.healun.2021.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
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15
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Guilherme E, Jacquet-Lagrèze M, Pozzi M, Achana F, Armoiry X, Fellahi JL. Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:442. [PMID: 32677985 PMCID: PMC7367381 DOI: 10.1186/s13054-020-03122-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used over the last decade in patients with refractory cardiogenic shock. ECMO weaning can, however, be challenging and lead to circulatory failure and death. Recent data suggest a potential benefit of levosimendan for ECMO weaning. We sought to further investigate whether the use of levosimendan could decrease the rate of ECMO weaning failure in adult patients with refractory cardiogenic shock. Methods We performed an observational single-center cohort study. All patients undergoing VA-ECMO from January 2012 to December 2018 were eligible and divided into two groups: group levosimendan and group control (without levosimendan). The primary endpoint was VA-ECMO weaning failure defined as death during VA-ECMO treatment or within 24 h after VA-ECMO removal. Secondary outcomes were mortality at day 28 and at 6 months. The two groups were compared after propensity score matching. P < 0.05 was considered statistically significant. Results Two hundred patients were analyzed (levosimendan group: n = 53 and control group: n = 147). No significant difference was found between groups on baseline characteristics except for ECMO duration, which was longer in the levosimendan group (10.6 ± 4.8 vs. 6.5 ± 4.7 days, p < 0.001). Levosimendan administration started 6.6 ± 5.4 days on average following ECMO implantation. After matching of 48 levosimendan patients to 78 control patients, the duration of ECMO was similar in both groups. The rate of weaning failure was 29.1% and 35.4% in levosimendan and control groups, respectively (OR: 0.69, 95%CI: 0.25–1.88). No significant difference was found between groups for all secondary outcomes. Conclusion Levosimendan did not improve the rate of successful VA-ECMO weaning in patients with refractory cardiogenic shock. Trial registration ClinicalTrials.gov, NCT04323709.
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Affiliation(s)
- Enrique Guilherme
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Matthias Jacquet-Lagrèze
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France. .,INSERM U1060, Laboratoire CarMeN, IHU OPeRa, Lyon, France.
| | - Matteo Pozzi
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Chirurgie Cardiaque, Lyon, France
| | - Felix Achana
- Nuffield Department of Primary care, Oxford University, Oxford, UK
| | - Xavier Armoiry
- Lyon School of Pharmacy (ISPB), Public Health department/UMR CNRS 5510 MATEIS, I2B Team, Lyon, France.,Division of Health Sciences, Warwick Medical School, Warwick university, Coventry, UK
| | - Jean-Luc Fellahi
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France.,INSERM U1060, Laboratoire CarMeN, IHU OPeRa, Lyon, France
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16
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Cheruku S, Dave S, Goff K, Park C, Ebeling C, Cohen L, Styrvoky K, Choi C, Anand V, Kershaw C. Cardiopulmonary Resuscitation in Intensive Care Unit Patients With Coronavirus Disease 2019. J Cardiothorac Vasc Anesth 2020; 34:2595-2603. [PMID: 32620487 PMCID: PMC7286272 DOI: 10.1053/j.jvca.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
Abstract
Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2–associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients’ rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.
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Affiliation(s)
- Sreekanth Cheruku
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX.
| | - Siddharth Dave
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Caroline Park
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Callie Ebeling
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Leah Cohen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Kim Styrvoky
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Vikram Anand
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Corey Kershaw
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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17
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Zochios V, Brodie D, Charlesworth M, Parhar KK. Delivering extracorporeal membrane oxygenation for patients with COVID-19: what, who, when and how? Anaesthesia 2020; 75:997-1001. [PMID: 32319081 PMCID: PMC7264794 DOI: 10.1111/anae.15099] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
- V Zochios
- Department of Cardiothoracic Critical Care and ECMO, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.,University of Birmingham, Institute of Inflammation and Ageing, Birmingham, UK
| | - D Brodie
- Columbia University College of Physicians and Surgeons, New York, NY, USA.,Centre for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - M Charlesworth
- Department of Cardiothoracic Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - K K Parhar
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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18
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19
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Mechanical Circulatory Support in Cardiogenic Shock: A Patient- Versus Device-Directed Approach. ASAIO J 2020; 66:e58. [PMID: 32106171 DOI: 10.1097/mat.0000000000001115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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20
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Chakaramakkil MJ, Sivathasan C. ECMO in cardiogenic shock and bridge to heart transplant. Indian J Thorac Cardiovasc Surg 2020; 37:319-326. [PMID: 33967452 DOI: 10.1007/s12055-020-00923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022] Open
Abstract
Purpose The aim of this review is to discuss the role of extracorporeal membrane oxygenation (ECMO) in cardiogenic shock and its use to bridge patients to heart transplantation. Methods and results Consideration of published literature reveals indications for ECMO in cardiogenic shock and tools for patient selection, adequate evidence of its efficacy, its advantages when compared with other temporary mechanical circulatory support devices and details of its use as a bridge to decision, bridge to recovery, bridge to bridge (durable ventricular assist device) and bridge to heart transplant. Conclusion ECMO is invaluable in treating patients with medically refractory profound cardiogenic shock and allows for cardiac recovery or planning for permanent heart replacement treatments.
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Affiliation(s)
- Mathew Jose Chakaramakkil
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital drive, Singapore, 169609 Singapore
| | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, 5 Hospital drive, Singapore, 169609 Singapore
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Extracorporeal Membrane Oxygenation Use in Cardiogenic Shock: Impact of Age on In-Hospital Mortality, Length of Stay, and Costs. Crit Care Med 2020; 47:e214-e221. [PMID: 30585830 DOI: 10.1097/ccm.0000000000003631] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Increasing age is a well-recognized risk factor for in-hospital mortality in patients receiving extracorporeal membrane oxygenation for cardiogenic shock, but the shape of this relationship is unknown. In addition, the impact of age on hospital length of stay, patterns of patient disposition, and costs has been incompletely characterized. DESIGN Retrospective analysis of the National Inpatient Sample. SETTING U.S. nonfederal hospitals, years 2004-2016. PATIENTS Adults with cardiogenic shock treated with extracorporeal membrane oxygenation (3,094; weighted national estimate: 15,415). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The mean age of extracorporeal membrane oxygenation recipients was 54.8 ± 15.4 years (range, 18-90 yr). Crude in-hospital mortality was 57.7%. Median time-to-death was 8 days (interquartile range, 3-17 d). A linear relationship between age and in-hospital mortality was observed with a 14% increase in the adjusted odds of in-hospital mortality for every 10-year increase in age (adjusted odds ratio, 1.14; 95% CI, 1.08-1.21; p < 0.0001). Thirty-four percent of patients were discharged alive at a median time of 30 days (interquartile range, 19-48 d). The median length of stay and total hospitalization costs were 14 days (interquartile range, [5-29 d]) and $134,573 ($71,782-$239,439), respectively, both of which differed significantly by age group (length of stay range from 17 d [18-49 yr] to 9 d [80-90 yr]; p < 0.0001 and cost range $147,548 [18-49 yr] to $105,350 [80-90 yr]; p < 0.0001). CONCLUSIONS Age is linearly associated with increasing in-hospital mortality in individuals receiving extracorporeal membrane oxygenation for cardiogenic shock without evidence of a threshold effect. Median time-to-death is approximately 1 week. One third of patients are discharged from the hospital alive, but the median time-to-discharge is 1 month. Median length of stay ranges from 9 to 17 days depending on age. Hospitalization costs exceed $100,000 in all age groups.
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22
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Zhu A, Zhang T, Hang X, Zhang X, Xiong Y, Fang T, Chen M. Hypoperfusion With Vomiting, Abdominal Pain, or Dizziness and Convulsions: An Alert to Fulminant Myocarditis in Children. Front Pediatr 2020; 8:186. [PMID: 32432061 PMCID: PMC7214534 DOI: 10.3389/fped.2020.00186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: To investigate the clinical features, treatment methods, and outcomes of fulminant myocarditis (FM) in children. Methods: The clinical data of 23 children with FM hospitalized in the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (Anhui Provincial Hospital) and Anhui Provincial Children's Hospital from January 2011 to September 2019 were retrospectively analyzed. Results: Among the 23 patients analyzed, 10 were male and 13 were female. The patients aged from 6 months to 14 years old (6.5 ± 3.4 years), and 18 patients were over 3 years old. There were 14 cases with respiratory symptoms, 16 cases with gastrointestinal symptoms, 15 cases with neurological symptoms, and 19 cases with hypoperfusion manifestations. Creatine kinase MB (CK-MB) and cardiac troponin I (CTnI) levels were increased in 19 and 21 cases, respectively. Electrocardiography (ECG) showed ST-T changes in 18 cases and atrioventricular blocks (AVB) in 15 cases. Echocardiography (ECHO) showed cardiac chamber enlargement (CCE) in eight cases, left ventricular systolic dysfunction in five cases, decrease in left ventricular ejection fraction (LVEF) in four cases, reduction in wall motion in two cases, and pericardial effusion in seven cases. Intravenous immunoglobulin (IVIG) and glucocorticoids were administered to 19 and 20 patients, respectively. Fourteen patients were treated with temporary pacemakers, one patient received extracorporeal membrane oxygenation (ECMO), one patient received continuous renal replacement therapy (CRRT), and one patient received ECMO combined with CRRT. Twenty patients improved at discharge, and three patients died. Conclusion: Preschool and school-age children showing hypoperfusion symptoms, such as paleness, cold, clammy limbs, and capillary refill time (CRT) extension, accompanied by vomiting, abdominal pain, dizziness, convulsions, and other symptoms, should be carefully examined for FM. CK-MB, CTnI, ECG, and echocardiogram need to be performed at the earliest opportunity. In the early stages of FM, vital signs should be actively monitored, high-dose IVIG and glucocorticoids should be administered, and life support technologies such as temporary pacemakers, ECMO, and CRRT should be used to increase the survival rate of children with FM as needed.
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Affiliation(s)
- Angang Zhu
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
| | - Tian Zhang
- Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xiaobi Hang
- Department of Pediatrics, Anhui Provincial Children's Hospital, Hefei, China
| | - Xiaoguang Zhang
- Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yingying Xiong
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
| | - Tao Fang
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China
| | - Mingwu Chen
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China.,Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China
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Zuo H, Li R, Ma F, Jiang J, Miao K, Li H, Nagel E, Tadic M, Wang H, Wang DW. Temporal echocardiography findings in patients with fulminant myocarditis: beyond ejection fraction decline. Front Med 2019; 14:284-292. [PMID: 31858367 DOI: 10.1007/s11684-019-0713-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/23/2019] [Indexed: 12/23/2022]
Abstract
The features of myocardial strains from speckle-tracking echocardiography (STE) have not been well defined in fulminant myocarditis (FM) patients. In this study, changes in the left ventricular ejection fraction (LVEF) and global and layer-specific myocardial strains over time were monitored. We aimed to determine the echocardiographic patterns of FM and ascertain their significance in FM treatment. Twenty patients who were clinically diagnosed with FM and received mechanical life support were prospectively enrolled. Conventional echocardiographic measurements were obtained, and serial strain echocardiography was performed from admission to hospital discharge until LVEF recovery (> 50%). Global/regional peak systolic longitudinal strains (GLS/RLS) and layer-specific longitudinal strains were quantified, and their changes with time were monitored in 14 FM patients. All patients had severely impaired cardiac function. Steep improvement in LVEF and GLS were observed within 6 days. Layer-specific strain analysis showed that reduction at admission or recovery at discharge in the endocardium and epicardium strains were equal. In conclusion, FM patients who received mechanical circulatory supports exhibited steep improvement in ventricular function within 6 days. The patchy and diffused distribution pattern of reduced RLS and equally and severely impaired strain in the endocardium and epicardium are valuable features in the diagnosis of FM.
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Affiliation(s)
- Houjuan Zuo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China
| | - Rui Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China
| | - Jiangang Jiang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China
| | - Kun Miao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China
| | - Haojie Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiologic Disorders, Wuhan, 430030, China.
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Abstract
RATIONALE Fulminant myocarditis (FM) has poor prognosis and the usual treatment is inotropes and symptomatic support. The initiation of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) in the emergency department (ED) is a rare event. PATIENT CONCERNS We report the case of a 45-year-old man with a complaint of 4 days of high fever and dry cough in the emergency department. DIAGNOSIS Transthoracic echocardiogram and the medical history showed presumptive diagnosis was fulminant myocarditis with cardiogenic shock. INTERVENTIONS The patient's condition deteriorated drastically and ECMO was initiated immediately after admission. He experienced electrical storm twice during ECMO support and was successfully treated with the combination with IABP. OUTCOMES ECMO and IABP were continued for 11 and 14 days respectively. The patient was discharged on the 81th day after admission, with all his laboratory tests returned to normal. LESSONS SUBSECTIONS The early initiation of ECMO and IABP in the ED is potentially life-saving for suitable patients with FM. It appears promising but has not yet been routinely implemented in underdeveloped and developing countries.
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25
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Chinese society of cardiology expert consensus statement on the diagnosis and treatment of adult fulminant myocarditis. SCIENCE CHINA-LIFE SCIENCES 2018; 62:187-202. [PMID: 30519877 PMCID: PMC7102358 DOI: 10.1007/s11427-018-9385-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 01/02/2023]
Abstract
Fulminant myocarditis is primarily caused by infection with any number of a variety of viruses. It arises quickly, progresses rapidly, and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock, with mortality rates as high as 50%–70%. Most importantly, there are no treatment options, guidelines or an expert consensus statement. Here, we provide the first expert consensus, the Chinese Society of Cardiology Expert Consensus Statement on the Diagnosis and Treatment of Fulminant Myocarditis, based on data from our recent clinical trial (NCT03268642). In this statement, we describe the clinical features and diagnostic criteria of fulminant myocarditis, and importantly, for the first time, we describe a new treatment regimen termed life support-based comprehensive treatment regimen. The core content of this treatment regimen includes (i) mechanical life support (applications of mechanical respirators and circulatory support systems, including intraaortic balloon pump and extracorporeal membrane oxygenation, (ii) immunological modulation by using sufficient doses of glucocorticoid, immunoglobulin and (iii) antiviral reagents using neuraminidase inhibitor. The proper application of this treatment regimen may and has helped to save the lives of many patients with fulminant myocarditis.
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Mechanical circulatory support in patients with cardiogenic shock in intensive care units: A position paper of the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology, endorsed by the "Groupe Athérome et Cardiologie Interventionnelle" of the French Society of Cardiology. Arch Cardiovasc Dis 2018; 111:601-612. [PMID: 29903693 DOI: 10.1016/j.acvd.2018.03.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 12/17/2022]
Abstract
Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines. A major change has resulted from the recent advent and availability of potent mechanical circulatory support (MCS) devices. These devices, which ensure sustained blood flow, provide a great and long-awaited opportunity to improve the prognosis of CS. Several efficient MCS devices are now available, including left ventricle-to-aorta circulatory support devices and full pulmonary and circulatory support with venoarterial extracorporeal membrane oxygenation. However, evidence to support their indications, the timing of implantation and the selection of patients and devices is scarce. Because these devices are gaining momentum and are becoming readily available, the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology aims to propose practical algorithms for the use of these devices, to help intensive care unit and cardiac care unit physicians in this complex area, where evidence is limited.
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Insufficient left ventricular unloading after extracorporeal membrane oxygenation : A case-series observational study. Herz 2018; 45:186-191. [PMID: 29777285 DOI: 10.1007/s00059-018-4711-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 04/23/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a method widely used to support circulation in patients with fulminant myocarditis (FM). However, a common complication associated with ECMO is left ventricular (LV) overload. METHODS This case series observed the effects of intra-aortic balloon pump (IABP) and beta-blockers for the treatment of LV overload after ECMO. The cases of eight patients with FM who underwent ECMO from September 2009 to July 2016 were reviewed. RESULTS Six of the eight patients survived. After ECMO treatment, insufficient LV unloading occurred in six patients. Among these six patients, three experienced electrical storm but spontaneous circulation returned after interventions with beta-blockers and IABP. The survivors demonstrated full recovery of cardiac function. CONCLUSION Beta-blockers may prevent the occurrence of electrical storm, and IABP is feasible for the treatment of LV overload after ECMO application.
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Matsumoto M, Asaumi Y, Nakamura Y, Nakatani T, Nagai T, Kanaya T, Kawakami S, Honda S, Kataoka Y, Nakajima S, Seguchi O, Yanase M, Nishimura K, Miyamoto Y, Kusano K, Anzai T, Noguchi T, Fujita T, Kobayashi J, Ishibashi-Ueda H, Shimokawa H, Yasuda S. Clinical determinants of successful weaning from extracorporeal membrane oxygenation in patients with fulminant myocarditis. ESC Heart Fail 2018; 5:675-684. [PMID: 29757498 PMCID: PMC6073023 DOI: 10.1002/ehf2.12291] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 01/10/2018] [Accepted: 03/17/2018] [Indexed: 11/25/2022] Open
Abstract
Aims Patients with fulminant myocarditis (FM) often present with cardiogenic shock and require mechanical circulatory support, including extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD) implantation. This study sought to clarify the determinants of successful weaning from ECMO in FM patients. Methods and results We studied 37 consecutive FM patients supported by ECMO as the initial form of mechanical circulatory support between January 1995 and December 2014 in our hospital. Twenty‐two (59%) patients were successfully weaned from ECMO, while 15 (41%) were not. There were significant differences in levels of peak creatine kinase and those of its MB isoform (CK‐MB), left ventricular posterior wall thickness (LVPWT), and prevalence of cardiac rhythm disturbances. Receiver operating characteristic curve analysis revealed that a peak CK‐MB level of 185 IU/L and LVPWT of 11 mm were the optimal cut‐off values for predicting successful weaning from ECMO (areas under the curve, 0.89 and 0.85, respectively). During the follow‐up [median 48 (interquartile range 8–147) months], 83% of FM patients who were weaned from ECMO survived, with preserved fractional shortening based on echocardiography. Of the 15 FM patients who were not weaned from ECMO, nine bridged to VAD, and only two were successfully weaned from VAD and survived. Conclusions These results indicate that myocardial injury, as evidenced by CK‐MB and LVPWT, and prolonged presence of cardiac rhythm disturbances are important clinical determinants of successful weaning from ECMO.
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Affiliation(s)
- Manabu Matsumoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Innovative Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nakamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Nakatani
- Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Shoji Kawakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Seiko Nakajima
- Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Osamu Seguchi
- Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hatsue Ishibashi-Ueda
- Department of Pathology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.,Department of Innovative Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Delmas C, Elbaz M, Bonello L, Biendel C, Bouisset F, Lairez O, Silva S, Marcheix B, Galinier M. Place de l’assistance circulatoire dans le choc cardiogénique en France en 2018 : revue de la littérature et perspectives. MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Le choc cardiogénique reste de nos jours une entité mal définie, assez fréquente en pratique clinique (60 000–70 000 cas/an en Europe), dont le pronostic est sombre, avec une mortalité souvent supérieure à 40 % à 30 jours. À travers cette revue de la littérature, nous essaierons de définir cette entité et ses étiologies, avant de parler de son incidence et de son pronostic. L’approche physiopathologique du choc cardiogénique nous permettra par la suite d’approcher sa prise en charge thérapeutique classique (gestion de la volémie, amines inotropes et vasoconstrictives, ventilation) et les limites de cette dernière. Ainsi, nous aborderons les assistances circulatoires et cardiocirculatoires disponibles en France, afin de les envisager au sein d’une stratégie globale de prise en charge du patient en choc cardiogénique. Nous discuterons plus spécifiquement leurs indications ainsi que l’importance du moment d’implantation afin d’optimiser leur efficacité. Enfin, nous évoquerons les assistances actuellement en développement, mais également les nouvelles stratégies thérapeutiques qui pourraient arriver dans les prochaines années.
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Ziperstein JC, Churchill TW, Hedgire SS, Dec GW, Stone JR. Case 13-2018: A 53-Year-Old Man with Cardiomyopathy and Recurrent Ventricular Tachycardia. N Engl J Med 2018; 378:1622-1633. [PMID: 29694808 DOI: 10.1056/nejmcpc1800333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Joshua C Ziperstein
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - Timothy W Churchill
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - Sandeep S Hedgire
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - G William Dec
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
| | - James R Stone
- From the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Massachusetts General Hospital, and the Departments of Medicine (J.C.Z., T.W.C., G.W.D.), Radiology (S.S.H.), and Pathology (J.R.S.), Harvard Medical School - both in Boston
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Abstract
Myocarditis is an inflammatory disease of the myocardium with a broad spectrum of clinical presentations, ranging from mild symptoms to severe heart failure. The course of patients with myocarditis is heterogeneous, varying from partial or full clinical recovery in few days to advanced low cardiac output syndrome requiring mechanical circulatory support or heart transplantation. Fulminant myocarditis (FM) is a peculiar clinical condition and is an acute form of myocarditis, whose main characteristic is a rapidly progressive clinical course with the need for hemodynamic support. Despite the common medical belief of the past decades, recent comprehensive data, including a recent registry that compared FM with acute non-FM, highlighted that FM has a poor inhospital outcome, often requires advanced hemodynamic support, and may result in residual left ventricular dysfunction in survivors. This review aimed to provide an updated practical definition of FM, including essentials in the diagnosis and management of the disease. Finally, the outcome of FM was critically revised according to the current published registries focusing on the topic.
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Li YT, Yang LF, Chen ZG, Pan L, Duan MQ, Hu Y, Zhou CB, Guo YX. ECMO as an effective rescue therapeutic for fulminant myocarditis complicated with refractory cardiac arrest. Ther Clin Risk Manag 2017; 13:1507-1511. [PMID: 29180869 PMCID: PMC5694204 DOI: 10.2147/tcrm.s147845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Fulminant myocarditis (FM) is a life-threatening disease in children. With a rapid, progressive course of deterioration, it causes refractory cardiorespiratory failure even with optimal clinical intervention. We present the case of a 9-year-old girl with FM complicated by cardiogenic shock, malignant arrhythmia, and refractory cardiac arrest. She received effective cardiopulmonary resuscitation, therapeutic hypothermia, and other supportive treatments. However, the patient rapidly worsened into pulseless ventricular tachycardia and refractory cardiac arrest. Therefore, we performed extracorporeal membrane oxygenation (ECMO) to establish spontaneous circulation after the failure of standard resuscitation measures. The girl recovered with intact cardiac and neurocognitive functions after continued ECMO treatment for 221 hours. Therefore, ECMO is an effective rescue therapeutics for FM, especially when complicated with refractory cardiac arrest.
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Affiliation(s)
- Ya-Ting Li
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Li-Fen Yang
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Zhuang-Gui Chen
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Li Pan
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Meng-Qi Duan
- Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou
| | - Yan Hu
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou
| | - Cheng-Bin Zhou
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Yu-Xiong Guo
- Pediatric Intensive Care Unit, Department of Pediatrics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou
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Castellanos-Moreira R, Rodríguez-García S, López-Sobrino T, Capdevila A, Prieto-González S, Espinosa G. Oxigenador extracorpóreo de membrana eficaz en una paciente con miocarditis lúpica fulminante. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Musa TA, Chue CD, Lim HS. Mechanical Circulatory Support for Decompensated Heart Failure. Curr Heart Fail Rep 2017; 14:365-375. [DOI: 10.1007/s11897-017-0349-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Abstract
Major advances have been made in mechanical circulatory support in recent years. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) provides both pulmonary and circulatory support for critically ill patients with hemodynamic compromise, serving as a bridge to recovery or definitive therapy in the form of transplant or a durable ventricular assist device. In the past, VA ECMO support was used in cases of cardiogenic shock or failure to wean from cardiopulmonary bypass; however, the technology is now being applied to an ever-expanding list of conditions, including massive pulmonary embolism, cardiac arrest, drug overdose, and hypothermia.
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Affiliation(s)
- Christopher S King
- Department of Medicine, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
| | - Aviral Roy
- Department of Critical Care, Cooper University Hospital, 427C Dorrance, 1 Cooper Plaza, Camden, NJ 08103, USA
| | - Liam Ryan
- Department of Cardiothoracic Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Ramesh Singh
- Department of Cardiothoracic Surgery, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
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36
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den Uil CA, Jewbali LS, Heeren MJ, Constantinescu AA, Van Mieghem NM, Reis Miranda DD. Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno-arterial extracorporeal membrane oxygenation. Eur J Heart Fail 2017; 19 Suppl 2:104-109. [DOI: 10.1002/ejhf.853] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Corstiaan A. den Uil
- Department of Cardiology, Thoraxcenter; Erasmus Medical Center; Rotterdam the Netherlands
- Department of Intensive Care Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - Lucia S. Jewbali
- Department of Cardiology, Thoraxcenter; Erasmus Medical Center; Rotterdam the Netherlands
- Department of Intensive Care Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - Martijn J. Heeren
- Department of Cardiothoracic Surgery, Thoraxcenter; Erasmus Medical Center; Rotterdam the Netherlands
| | | | - Nicolas M. Van Mieghem
- Department of Cardiology, Thoraxcenter; Erasmus Medical Center; Rotterdam the Netherlands
| | - Dinis dos Reis Miranda
- Department of Intensive Care Medicine; Erasmus Medical Center; Rotterdam the Netherlands
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37
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Einecke G, Beutel G, Hoeper MM, Kielstein JT. The answer is blowing in the wind: an uncommon cause for severe ARDS accompanied by circulatory insufficiency requiring extracorporeal membrane oxygenation. BMJ Case Rep 2017; 2017:bcr-2016-218079. [PMID: 28343152 DOI: 10.1136/bcr-2016-218079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a rare complication in an immunosuppressed patient with IgA nephropathy who suffered from severe acute respiratory distress syndrome, severe capillary leakage and shock after placement of a double lumen central venous catheter. He could be successfully treated by extracorporeal membrane oxygenation (ECMO) and therapeutic plasma exchange. This report highlights the severity of late-onset complications of catheter placements and shows the potential of ECMO treatment for the management of acute illnesses with bridge to recovery.
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Affiliation(s)
- Gunilla Einecke
- Department of Nephrology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gernot Beutel
- Department of Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, Medizinische Hochschule Hannover, Hannover, Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology, Stadtisches Klinikum Braunschweig GmbH, Braunschweig, Germany
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Inaba O, Satoh Y, Isobe M, Yamamoto T, Nagao K, Takayama M. Factors and values at admission that predict a fulminant course of acute myocarditis: data from Tokyo CCU network database. Heart Vessels 2017; 32:952-959. [PMID: 28255801 DOI: 10.1007/s00380-017-0960-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/10/2017] [Indexed: 12/30/2022]
Abstract
Prognosis of acute myocarditis is generally benign, but fulminant cases exist which require advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular assist devices (VAD), and lead to fatal outcomes. The purpose of this study was to identify predictors and their values at admission which might foreshadow a fulminant course of myocarditis. Data from 138 patients (mean age 42.0 years, 79 males) with a diagnosis of acute myocarditis in the Tokyo CCU Network database from 2007 to 2009 were analyzed retrospectively. Patients were divided into fulminant (in-hospital death, or PCPS or VAD requirement, N = 42) and non-fulminant groups (N = 96). Clinical data at admission were compared between them. Overall in-hospital mortality was 14.5%. On multivariate analysis, low systolic blood pressure (BPsys, odds ratio (OR)/mmHg 0.97; 95% confidence interval (CI) 0.93-1.00, p = 0.032) and electrocardiographic QRS complex prolongation (OR/10 ms 1.28; 95% CI 1.10-1.59, p = 0.0034) at admission were independent factors associated with a fulminant course. By receiver operator characteristic curve analysis, the area under the curve predicting a fulminant course was 0.769 for low BPsys and 0.821 for prolongation of QRS duration. The optimal cut-off value was 101 mmHg for BPsys (sensitivity 79.5%, specificity 68.0%), and 120 ms for QRS duration (sensitivity 72.2%, specificity 88.0%). Systolic hypotension and prolonged QRS on admission are predictors of a fulminant course of myocarditis.
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Affiliation(s)
- Osamu Inaba
- Tokyo CCU Network Scientific Committee, Tokyo, Japan. .,Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee, Tokyo, Japan
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Successful Extracorporeal Membrane Oxygenation in a Patient With Fulminant Lupus Myocarditis. ACTA ACUST UNITED AC 2017; 70:1013-1014. [PMID: 28131563 DOI: 10.1016/j.rec.2016.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022]
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40
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Fatal Dengue Myocarditis despite the Use of Extracorporeal Membrane Oxygenation. Case Rep Infect Dis 2016; 2016:5627217. [PMID: 28018687 PMCID: PMC5149615 DOI: 10.1155/2016/5627217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 10/26/2016] [Accepted: 11/15/2016] [Indexed: 01/12/2023] Open
Abstract
Dengue is an important mosquitoes-borne viral disease which is endemic in tropics and subtropics region. Rapid spreading of disease to previously unaffected region was found in recent years. Atypical manifestations, such as myocarditis, were reported during large outbreak. There is a wide range of clinical manifestations of cardiac involvement in dengue, but rarely fatal. Here we reported a case of fulminant dengue myocarditis in fatal outcome despite cardiac mechanical support.
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Singal RK, Singal D, Bednarczyk J, Lamarche Y, Singh G, Rao V, Kanji HD, Arora RC, Manji RA, Fan E, Nagpal AD. Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest. Can J Cardiol 2016; 33:51-60. [PMID: 28024556 DOI: 10.1016/j.cjca.2016.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 01/06/2023] Open
Abstract
Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field.
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Affiliation(s)
- Rohit K Singal
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deepa Singal
- Department of Community Health Sciences, Max Rady College of Medicine, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Bednarczyk
- Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute and Department of Critical Care, Hôpital du Sacré Coeur de Montréal, Université de Montréal, Québec, Canada
| | - Gurmeet Singh
- Departments of Critical Care Medicine and Surgery, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hussein D Kanji
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rizwan A Manji
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Critical Care, Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - A Dave Nagpal
- London Health Sciences Centre/Western University, London Ontario, Canada
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Extracorporeal Life Support: Physiological Concepts and Clinical Outcomes. J Card Fail 2016; 23:181-196. [PMID: 27989868 DOI: 10.1016/j.cardfail.2016.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022]
Abstract
Extracorporeal life support (ECLS) describes a system that involves drainage from the venous circulation and return via an oxygenator into the arterial circulation (veno-arterial extracorporeal membrane oxygenation). ECLS provides effective cardiopulmonary support, but the parallel circulation has complex effects on the systemic and pulmonary circulatory physiology. An understanding of the physiological changes is fundamental to the management of ECLS. In this review, the key physiological concepts and the implications on the clinical management of ECLS are discussed. In addition, the clinical outcomes associated with ECLS in cardiogenic shock are systematically reviewed. The paucity of clinical trials on ECLS highlights the need for randomized trials to guide the selection of patients.
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Cheng R, Ramzy D, Azarbal B, Arabia FA, Esmailian F, Czer LS, Kobashigawa JA, Moriguchi JD. Device Strategies for Patients in INTERMACS Profiles 1 and 2 Cardiogenic Shock: Double Bridge With Extracorporeal Membrane Oxygenation and Initial Implant of More Durable Devices. Artif Organs 2016; 41:224-232. [DOI: 10.1111/aor.12758] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/29/2016] [Accepted: 03/22/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Richard Cheng
- Division of Cardiology; Cedars-Sinai Heart Institute
| | - Danny Ramzy
- Division of Cardiothoracic Surgery; Cedars-Sinai Heart Institute; Los Angeles CA USA
| | - Babak Azarbal
- Division of Cardiology; Cedars-Sinai Heart Institute
| | - Francisco A. Arabia
- Division of Cardiothoracic Surgery; Cedars-Sinai Heart Institute; Los Angeles CA USA
| | - Fardad Esmailian
- Division of Cardiothoracic Surgery; Cedars-Sinai Heart Institute; Los Angeles CA USA
| | | | | | - Jaime D. Moriguchi
- Division of Cardiology; Cedars-Sinai Heart Institute
- Division of Cardiothoracic Surgery; Cedars-Sinai Heart Institute; Los Angeles CA USA
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Pozzi M, Banfi C, Grinberg D, Koffel C, Bendjelid K, Robin J, Giraud R, Obadia JF. Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 2016; 8:E495-502. [PMID: 27499982 DOI: 10.21037/jtd.2016.06.26] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS). The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients.
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Affiliation(s)
- Matteo Pozzi
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Carlo Banfi
- Division of Cardiovascular Surgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Daniel Grinberg
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Catherine Koffel
- Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Karim Bendjelid
- Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jacques Robin
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
| | - Raphaël Giraud
- Intensive Care Service, Geneva University Hospitals, Faculty of Medicine, University of Geneva, Geneva Hemodynamic Research Group, Geneva, Switzerland
| | - Jean François Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Claude Bernard University, Lyon, France
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Nakajima S, Seguchi O, Fujita T, Hata H, Yamashita K, Sato T, Sunami H, Yanase M, Fukushima N, Kobayashi J, Nakatani T. Successful treatment of near-fatal fulminant myocarditis using bi-ventricular assist device support. J Artif Organs 2016; 19:293-6. [PMID: 27052930 DOI: 10.1007/s10047-016-0899-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
Fulminant myocarditis is a rare but fatal serious disease that may cause prolonged native cardiac dysfunction with multiorgan failure despite temporary mechanical circulatory support with percutaneous venoatrial extracorporeal membrane oxygenation (VA-ECMO) or intraaortic balloon pumping (IABP). A 26-year-old man with fulminant myocarditis developed life-threatening multiorgan failure after 8 days support by VA-ECMO and IABP. He was transferred to our institution with prolonged cardiac dysfunction on hospital day 8; massive pulmonary edema developed into severe pulmonary dysfunction. Immediately after admission, VA-ECMO and IABP were switched to a paracorporeal pneumatic left ventricular assist device (LVAD) and right centrifugal ventricular assist device with an ECMO circuit shunting from the right ventricle to the pulmonary artery (RVAD-ECMO). After intensive care focusing on respiratory dysfunction, ECMO was successfully weaned, and the right ventricular assist device was switched to a durable paracorporeal pneumatic right ventricular assist device. The paracorporeal bi-ventricular assist devices were finally replaced with an implantable non-pulsatile LVAD on hospital day 181. Currently, 1 year after discharge, the patient is at home awaiting heart transplantation. Combined LVAD and RVAD-ECMO appear to be useful for resolving severe pulmonary edema due to unnecessarily long VA-ECMO support as well as kidney or liver dysfunction caused by circulatory collapse.
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Affiliation(s)
- Seiko Nakajima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Osamu Seguchi
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan.
| | - Tomoyuki Fujita
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Hiroki Hata
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Kizuku Yamashita
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Takuma Sato
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Haruki Sunami
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Masanobu Yanase
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Norihide Fukushima
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Junjiro Kobayashi
- Department of Adult Cardiac Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | - Takeshi Nakatani
- Department of Transplant Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
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Lorusso R, Centofanti P, Gelsomino S, Barili F, Di Mauro M, Orlando P, Botta L, Milazzo F, Actis Dato G, Casabona R, Casali G, Musumeci F, De Bonis M, Zangrillo A, Alfieri O, Pellegrini C, Mazzola S, Coletti G, Vizzardi E, Bianco R, Gerosa G, Massetti M, Caldaroni F, Pilato E, Pacini D, Di Bartolomeo R, Marinelli G, Sponga S, Livi U, Mauro R, Mariscalco G, Beghi C, Miceli A, Glauber M, Pappalardo F, Russo CF. Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience. Ann Thorac Surg 2015; 101:919-26. [PMID: 26518372 DOI: 10.1016/j.athoracsur.2015.08.014] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/31/2015] [Accepted: 08/07/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period. METHOD From hospital databases, 57 patients with diagnoses of AFM treated with VA-ECMO in the past 5 years were found and analyzed. Mean age was 37.6 ± 11.8 years; 37 patients were women. At VA-ECMO implantation, cardiogenic shock was present in 38 patients, cardiac arrest in 12, and severe hemodynamic instability in 7. A peripheral approach was used with 47 patients, whereas 10 patients had a central implantation or other access. RESULTS Mean VA-ECMO support was 9.9 ± 19 days (range, 2 to 24 days). Cardiac recovery with ECMO weaning was achieved in 43 patients (75.5%), major complications were observed in 40 patients (70.1%), and survival to hospital discharge occurred in 41 patients (71.9%). After hospital discharge (median follow-up, 15 months) there were 2 late deaths. The 5-year actual survival was 65.2% ± 7.9%, with recurrent self-recovering myocarditis observed in 2 patients (at 6 and 12 months from the first AFM event), and 1 heart transplantation. CONCLUSIONS Cardiopulmonary support with VA-ECMO provides an invaluable tool in the treatment of AFM, although major complications may characterize the hospital course. Long-term outcome appears favorable with rare episodes of recurrent myocarditis or cardiac-related events.
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Affiliation(s)
- Roberto Lorusso
- Cardiac Surgery Unit, Spedali Civili Hospital, Brescia, Italy.
| | | | - Sandro Gelsomino
- Cardiovascular Research Centre, Careggi Hospital, Florence, Italy
| | - Fabio Barili
- Cardiac Surgery Unit, S. Anna Hospital, Cuneo, Italy
| | | | - Parise Orlando
- Cardiovascular Research Centre, Careggi Hospital, Florence, Italy
| | - Luca Botta
- Cardiac Surgery Unit, Niguarda Hospital, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gino Gerosa
- Cardiac Surgery Unit, University Hospital, Padua, Italy
| | | | | | | | | | | | | | | | | | | | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, United Kingdom
| | | | - Antonio Miceli
- Pasquinucci Hospital Fondazione Monasterio, Massa, Italy
| | - Mattia Glauber
- Pasquinucci Hospital Fondazione Monasterio, Massa, Italy
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Hu W, Chen L, Liu C, Hu W, Lu J, Zhu Y, Wang J, Liu B. Three cases of electrical storm in fulminant myocarditis treated by extracorporeal membrane oxygenation. Am J Emerg Med 2015; 33:606.e3-8. [DOI: 10.1016/j.ajem.2014.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/11/2014] [Indexed: 11/26/2022] Open
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Lin TC, Lee HC, Lee WH, Su HM, Lin TH, Hsu PC. Fulminant dengue myocarditis complicated with profound shock and fatal outcome under intra-aortic balloon pumping support. Am J Emerg Med 2015; 33:1716.e1-3. [PMID: 25819204 DOI: 10.1016/j.ajem.2015.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/15/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tzu-Chieh Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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49
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Isogai T, Yasunaga H, Matsui H, Tanaka H, Horiguchi H, Fushimi K. Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses. J Card Fail 2015; 21:391-397. [PMID: 25639690 DOI: 10.1016/j.cardfail.2015.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 12/31/2014] [Accepted: 01/23/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fulminant myocarditis (FM) is a rare but life-threatening disease. Intravenous immunoglobulin (IVIG) is not recommended for acute or chronic myocarditis in Western nations owing to the lack of rigorous evidence, but it is widely used in other countries, including Japan. This nationwide retrospective cohort study focused on evaluating the effect of IVIG in FM patients. METHODS AND RESULTS Using the Diagnosis Procedure Combination database in Japan, we identified 603 FM patients aged ≥16 years who received mechanical circulatory support within 7 days after admission. We performed propensity score analyses to compare the in-hospital mortality and total costs between IVIG users (n = 220; 36.5%) and nonusers (n = 383; 63.5%). Among propensity score-matched patients (164 pairs), there was no significant difference in in-hospital mortality between IVIG users and nonusers (36.6% vs 37.2%; P = .909). A multivariable logistic regression analysis showed no significant association between IVIG use and in-hospital mortality (adjusted odds ratio 0.91; 95% confidence interval 0.52 to 1.58; P = .733). The median total costs were significantly higher for IVIG users than for nonusers (US $44,226 vs $33,280; P < .001). CONCLUSION IVIG for FM was not significantly associated with a decrease in in-hospital mortality.
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Affiliation(s)
- Toshiaki Isogai
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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50
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Extracorporeal Life Support in Adults With Hemodynamic Collapse from Fulminant Cardiomyopathies. ASAIO J 2014; 60:664-9. [DOI: 10.1097/mat.0000000000000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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