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Kayali F, Agbobu T, Moothathamby T, Jubouri YF, Jubouri M, Abdelhaliem A, Ghattas SNS, Rezk SSS, Bailey DM, Williams IM, Awad WI, Bashir M. Haemodynamic support with percutaneous devices in patients with cardiogenic shock: the current evidence of mechanical circulatory support. Expert Rev Med Devices 2024:1-10. [PMID: 39087797 DOI: 10.1080/17434440.2024.2380330] [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: 01/31/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Cardiogenic shock (CS) is a complex life-threatening condition that results from primary cardiac dysfunction, leading to persistent hypotension and systemic hypoperfusion. Among the therapeutic options for CS are various percutaneous mechanical circulatory support (MCS) devices that have emerged as an increasingly effective hemodynamic support option. Percutaneous therapies can act as short-term mechanical circulatory assistance and can be split into intra-aortic balloon pump (IABP) and non-IABP percutaneous mechanical devices. AREAS COVERED This review will evaluate the MCS value while considering the mortality rate improvements. We also aim to outline the function of pharmacotherapies and percutaneous hemodynamic MCS devices in managing CS patients to avoid the onset of end-organ dysfunction and improve both early and late outcomes. EXPERT OPINION Given the complexity, acuity and high mortality associated with CS, and despite the availability and efficacy of pharmacological management, MCS is required to achieve hemodynamic stability and improve survival. Various percutaneous MCS devices are available with varying indications and clinical outcomes. The rates of early mortality and complications were found to be comparable between the four devices, yet, IABP seemed to show the most optimal clinical profile whilst ECMO demonstrated its more long-term efficacy.
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Affiliation(s)
- Fatima Kayali
- University Hospitals Sussex N.H.S. Foundation Trust, Sussex, UK
| | | | - Thurkga Moothathamby
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Amr Abdelhaliem
- Vascular and Endovascular Surgery, Royal Blackburn Hospital, Blackburn, UK
| | | | | | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | - Wael I Awad
- Department of Cardiothoracic Surgery, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Son YJ, Hyun Park S, Lee Y, Lee HJ. Prevalence and risk factors for in-hospital mortality of adult patients on veno-arterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 85:103756. [PMID: 38943815 DOI: 10.1016/j.iccn.2024.103756] [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: 04/18/2024] [Revised: 05/30/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES To synthesize quantitative research findings on the prevalence and risk factors for in-hospital mortality of patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). METHODS A comprehensive search was conducted for the period from May 2008 to December 2023 by searching the five electronic databases of PubMed, CINAHL, Web of Science, EMBASE, and Cochrane library. The quality of included studies was assessed using the Newcastle-Ottawa scale. The meta-analysis estimated the pooled odds ratio or standard mean difference and 95% confidence intervals. RESULTS A total of twenty-five studies with 10,409 patients were included in the analysis. The overall in-hospital mortality of patients on VA-ECMO was 56.7 %. In the subgroup analysis, in-hospital mortality of VA-ECMO for cardiogenic shock and cardiac arrest was 49.2 % and 75.2 %, respectively. The number of significant factors associated with an increased risk of in-hospital mortality in the pre-ECMO period (age, body weight, creatinine, chronic kidney disease, pH, and lactic acid) was greater than that in the intra- and post-ECMO periods. Renal replacement, bleeding, and lower limb ischemia were the most significant risk factors for in-hospital mortality in patients receiving VA-ECMO. CONCLUSION Early detection of the identified risk factors can contribute to reducing in-hospital mortality in patients on VA-ECMO. Intensive care unit nurses should provide timely and appropriate care before, during, and after VA-ECMO. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care unit nurses should be knowledgeable about factors associated with the in-hospital mortality of patients on VA-ECMO to improve outcomes. The present findings may contribute to developing guidelines for reducing in-hospital mortality among patients considering ECMO.
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Affiliation(s)
- Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
| | - So Hyun Park
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok ro, Dongjak-gu, Seoul 06974, South Korea.
| | - Youngeon Lee
- Emergency Intensive Care Unit, Department of Nursing, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea.
| | - Hyeon-Ju Lee
- Department of Nursing, Tongmyoung University, Busan 48520, South Korea.
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Kochar A, Vallabhajosyula S, John K, Sinha SS, Esposito M, Pahuja M, Hirst C, Li S, Kong Q, Li B, Natov P, Kanwar M, Hernandez-Montfort J, Garan R, Walec K, Zazzali P, Sangal P, Ton VK, Zweck E, Kataria R, Guglin M, Vorovich E, Nathan S, Abraham J, Harwani NM, Hickey GW, Wencker D, Schwartzman AD, Khalife W, Mahr C, Kim JH, Bhimaraj A, Blumer V, Faugno A, Burkhoff D, Kapur NK. Factors associated with Acute Limb Ischemia in Cardiogenic Shock and downstream Clinical Outcomes: Insights from the Cardiogenic Shock Working Group. J Heart Lung Transplant 2024:S1053-2498(24)01705-4. [PMID: 38944132 DOI: 10.1016/j.healun.2024.06.012] [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: 01/31/2024] [Revised: 05/29/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND There are limited data depicting the prevalence and ramifications of acute limb ischemia (ALI) among cardiogenic shock (CS) patients. METHODS We employed data from the Cardiogenic Shock Working Group (CSWG), a consortium including 33 sites. We constructed a multi-variable logistic regression to examine the association between clinical factors and ALI, we generated another logistic regression model to ascertain the association of ALI with mortality. RESULTS There were 7,070 patients with CS and 399 (5.6%) developed ALI. Patients with ALI were more likely to be female (40.4% versus 29.4%) and have peripheral arterial disease (13.8% versus 8.3%). Stratified by maximum SCAI shock stage, the rates of ALI were stage B 0.0%, stage C 1.8%, stage D 4.1%, and stage E 10.3%. Factors associated with higher risk for ALI included: peripheral vascular disease OR 2.24 (95% CI: 1.53 - 3.23; p < 0.01) and ≥ 2 mechanical circulatory support (MCS) devices OR 1.66 (95% CI: 1.24 - 2.21, p < 0.01). ALI was highest for VA-ECMO patients (11.6%) or VA-ECMO + IABP/Impella CP (16.6%) yet use of distal perfusion catheters was less than 50%. Mortality was 38.0% for CS patients without ALI but 57.4% for CS patients with ALI. ALI was significantly associated with mortality, adjusted OR 1.40 (95% CI 1.01 - 1.95, p < 0.01). CONCLUSIONS The rate of ALI was 6% among CS patients. Factors most associated with ALI include peripheral vascular disease and multiple MCS devices. The downstream ramifications of ALI were dire with a considerably higher risk of mortality.
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Affiliation(s)
| | | | - Kevin John
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, VA
| | | | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, OK
| | - Colin Hirst
- St. Peter's Health Partners Medical Associates, Albany, NY
| | - Song Li
- Institute for Advanced Cardiac Care, Medical City Healthcare, Dallas, TX
| | - Qiuyue Kong
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Peter Natov
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Manreet Kanwar
- Cardiovascular Instittue at Allegheny Health Network, Pittsburgh, PA
| | | | - Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Karol Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | - Van-Khue Ton
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA
| | - Elric Zweck
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rachna Kataria
- Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Esther Vorovich
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, IL
| | | | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | | | - Detlef Wencker
- Baylor Scott & White Health, Advanced Heart Failure Program Clinic, Temple, TX
| | | | | | - Claudius Mahr
- University of Washington Medical Center, Seattle, WA
| | - Ju H Kim
- Houston Methodist Research Institute, Houston, TX
| | | | - Vanessa Blumer
- Inova Heart and Vascular Institute, Inova Fairfax Campus, Falls Church, VA
| | - Anthony Faugno
- The Cardiovascular Center, Tufts Medical Center, Boston, MA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA.
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Safaya A, Yang S, Giglia JS, Moura Leite JO. Ipsilateral dual cannulation is associated with wound complications following veno-arterial ECMO decannulation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:296-301. [PMID: 39007557 DOI: 10.23736/s0021-9509.24.12874-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a well-established treatment for severe cardio-pulmonary failure. The use of large bore cannulas in the femoral vessels for an extended period has been associated with significant wound complications. There is a lack of data analyzing risk factors that can mitigate such complications. The primary purpose of this study was to identify modifiable risk factors associated with femoral wound complications after VA ECMO decannulation. METHODS Retrospective analysis of wound complications in patients following VA ECMO decannulation from 2014-2021 at a single academic institution were analyzed. Wound complications were defined as wound infection, dehiscence, or those wounds that were deliberately opened to promote healing by secondary intention. RESULTS Sixty patients underwent decannulation of VA ECMO with operative repair of the femoral artery. Fifteen patients were identified to have wound complications, eight (53%) of these had infection. Fourteen (93%) patients had wound dehiscence or had their wound purposely opened at bedside. Univariate analysis revealed no association of access-related complication with higher Body Mass Index (BMI, 28.3 vs. 32.7 kg/m2, P=0.110) but here was a trend in having more wound complications in individuals with COVID-19 infection (6.7% vs. 26.7%, P=0.058). Patients that had dual cannulation with the arterial and venous cannulas in the same groin had significantly more wound complications compared to single cannulation arterial and venous cannulas in separate groins (57.8% vs. 93.3%; P=0.012). Multivariate analysis revealed same side cannulation (OR 18.05, 95% CI 1.44-226.18, P=0.025) and COVID-19 infection (OR 18.18, 95% CI 1.50-220.66, P=0.023) were independent predictors of wound complications. CONCLUSIONS Wound complications after VA ECMO decannulation is associated with COVID-19 infection and having venous and arterial cannulas in the same groin. We recommend that the arterial and venous cannulation be placed in different groins in patients that require VA ECMO.
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Affiliation(s)
- Aditya Safaya
- Division of Vascular Surgery, Department of General Surgery, Penn State University Milton S. Hershy Medical Center, Hershey, PA, USA -
| | - Sung Yang
- Division of Vascular Surgery, Department of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Joseph S Giglia
- Division of Vascular Surgery, Department of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jose O Moura Leite
- Division of Vascular Surgery, Department of General Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Piccone G, Schiavoni L, Mattei A, Benedetto M. Extracorporeal Life Support in Myocardial Infarction: New Highlights. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:907. [PMID: 38929524 PMCID: PMC11205984 DOI: 10.3390/medicina60060907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Cardiogenic shock (CS) is a potentially severe complication following acute myocardial infarction (AMI). The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in these patients has risen significantly over the past two decades, especially when conventional treatments fail. Our aim is to provide an overview of the role of VA-ECMO in CS complicating AMI, with the most recent literature highlights. Materials and Methods: We have reviewed the current VA-ECMO practices with a particular focus on CS complicating AMI. The largest studies reporting the most significant results, i.e., overall clinical outcomes and management of the weaning process, were identified in the PubMed database from 2019 to 2024. Results: The literature about the use of VA-ECMO in CS complicating AMI primarily has consisted of observational studies until 2019, generating the need for randomized controlled trials. The EURO-SHOCK trial showed a lower 30-day all-cause mortality rate in patients receiving VA-ECMO compared to those receiving standard therapy. The ECMO-CS trial compared immediate VA-ECMO implementation with early conservative therapy, with a similar mortality rate between the two groups. The ECLS-SHOCK trial, the largest randomized controlled trial in this field, found no significant difference in mortality at 30 days between the ECMO group and the control group. Recent studies suggest the potential benefits of combining left ventricular unloading devices with VA-ECMO, but they also highlight the increased complication rate, such as bleeding and vascular issues. The routine use of VA-ECMO in AMI complicated by CS cannot be universally supported due to limited evidence and associated risks. Ongoing trials like the Danger Shock, Anchor, and Recover IV trials aim to provide further insights into the management of AMI complicated by CS. Conclusions: Standardizing the timing and indications for initiating mechanical circulatory support (MCS) is crucial and should guide future trials. Multidisciplinary approaches tailored to individual patient needs are essential to minimize complications from unnecessary MCS device initiation.
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Affiliation(s)
- Giulia Piccone
- Cardiothoracic and Vascular Intensive Care Unit, Hospital and University Trust of Verona, P. le A. Stefani, 37124 Verona, Italy;
| | - Lorenzo Schiavoni
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus-Bio-Medico, Via Alvaro del Portillo 200, 00127 Roma, Italy;
| | - Alessia Mattei
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus-Bio-Medico, Via Alvaro del Portillo 200, 00127 Roma, Italy;
| | - Maria Benedetto
- Cardio-thoracic and Vascular Anesthesia and Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy;
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Xenitopoulou MP, Ziampa K, Evangeliou AP, Tzikas S, Vassilikos V. Percutaneous Mechanical Circulatory Support in Acute Heart Failure Complicated with Cardiogenic Shock. J Clin Med 2024; 13:2642. [PMID: 38731171 PMCID: PMC11084767 DOI: 10.3390/jcm13092642] [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: 03/16/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Despite advancements in algorithms concerning the management of cardiogenic shock, current guidelines still lack the adequate integration of mechanical circulatory support devices. In recent years, more and more devices have been developed to provide circulatory with or without respiratory support, when conservative treatment with inotropic agents and vasopressors has failed. Mechanical circulatory support can be contemplated for patients with severe, refractory, or acute-coronary-syndrome-related cardiogenic shock. Through this narrative review, we delve into the differences among the types of currently used devices by presenting their notable advantages and inconveniences. We address the technical issues emerging while choosing the best possible device, temporarily as a bridge to another treatment plan or as a destination therapy, in the optimal timing for each type of patient. We also highlight the diverse implantation and removal techniques to avoid major complications such as bleeding and limb ischemia. Ultimately, we hope to shed some light in the gaps of evidence and the importance of conducting further organized studies around the topic of mechanical circulatory support when dealing with such a high mortality rate.
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Affiliation(s)
| | | | | | - Stergios Tzikas
- 3rd Department of Cardiology, Aristotle University of Thessaloniki, 546 42 Thessaloniki, Greece
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Gouchoe DA, Chaurasia S, Henn MC, Whitson BA, Mokadam NA, Mast D, Satyapriya S, Vallakati A, Ganapathi AM. Does Size Matter? The Effect of Size of Distal Perfusion Catheter on Acute Limb Ischemia: A Meta-Analysis. ASAIO J 2024:00002480-990000000-00431. [PMID: 38446827 DOI: 10.1097/mat.0000000000002178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Prevention of limb ischemia in patients with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is primarily achieved through the use of distal perfusion catheters (DPC). Our objective was to assess the role of DPC, and specifically the size of the catheter, in reducing the incidence of acute limb ischemia (ALI) through a meta-analysis. Seventeen studies met criteria for analysis. Pooled analysis included a total of 2,040 patients, of which 904 patients received ECMO with DPC and 1,136 patients underwent ECMO without DPC. Compared with ECMO alone, ECMO with DPC, regardless of size, significantly decreased ALI (relative risk [RR]: 0.49, 95% confidence interval [CI]: 0.31-0.77; p = 0.002). When comparing reactive versus prophylactic placement of DPC, prophylactic DPC was associated with significantly decreased ALI (RR: 0.41, 95% CI: 0.24-0.71; p = 0.02). No differences in mortality (RR: 0.89, 95% CI: 0.76-1.03; p = 0.12) and bleeding events (RR: 1.43, 95% CI: 0.41-4.96; p = 0.58) were observed between the two groups. This analysis demonstrates that the placement of DPC, if done prophylactically and regardless of size, is associated with a reduced risk of ALI versus the absence of DPC placement, but is not associated with differences in mortality or bleeding events.
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Affiliation(s)
- Doug A Gouchoe
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sameer Chaurasia
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio
| | - Matthew C Henn
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David Mast
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sree Satyapriya
- Division of Critical Care Medicine, Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ajay Vallakati
- Division of Cardiovascular Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asvin M Ganapathi
- From the Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Wiley BM, Zern EK. Defining Training in Critical Care Cardiology: What Is the "Gold Standard?". JACC. ADVANCES 2024; 3:100849. [PMID: 38938824 PMCID: PMC11198660 DOI: 10.1016/j.jacadv.2024.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Brandon M. Wiley
- Division of Cardiology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Emily K. Zern
- Division of Cardiology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Hockstein MA, Fan E. The Roles of Venopulmonary Arterial Extracorporeal Membrane Oxygenation. Crit Care Med 2024; 52:297-306. [PMID: 37909826 DOI: 10.1097/ccm.0000000000006094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Concise definitive review of the use of venopulmonary arterial extracorporeal membrane oxygenation (V-PA ECMO) support in patients with cardiopulmonary failure. DATA SOURCES Original investigations identified through a PubMed search with search terms "percutaneous right ventricular assist device," "oxy-RVAD," "V-PA ECMO," and "veno-pulmonary arterial ECMO" were reviewed and evaluated for relevance. STUDY SELECTION Studies that included more than three patients supported with V-PA ECMO were included. DATA EXTRACTION Clinically relevant data from included studies, including patient-important outcomes, were summarized and discussed. DATA SYNTHESIS We identified four groups of patients where V-PA ECMO has been studied: acute respiratory distress syndrome, right ventricular dysfunction after left ventricular assist device placement, bridge to lung transplantation, and pulmonary embolism. Most identified works are small, single center, and retrospective in nature, precluding definitive conclusions regarding the efficacy of V-PA ECMO. There have been no clinical trials evaluating the efficacy of V-PA ECMO for any indication. CONCLUSIONS V-PA ECMO is a promising form of extracorporeal support for patients with right ventricular dysfunction. Future work should focus on identifying the optimal timing and populations for the use of V-PA ECMO.
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Affiliation(s)
- Maxwell A Hockstein
- Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Altshuler PJ, Pace DJ, Preston WA, Vincent SA, Shah AP, Glorioso JM, Maley WR, Frank AM, Ramirez CB, West S, Hasz R, Bodzin AS. Assessing Kidney Transplantation Using ECMO-Supported Donors Within a KDPI-Based Allocation System. Transplant Direct 2023; 9:e1521. [PMID: 37829245 PMCID: PMC10566806 DOI: 10.1097/txd.0000000000001521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 10/14/2023] Open
Abstract
Background Organ donors supported by extracorporeal membrane oxygenation (ECMO) have historically been considered high-risk and are judiciously utilized. This study examines transplant outcomes using renal allografts from donors supported on ECMO for nondonation purposes. Methods Retrospective review of the Gift of Life (Pennsylvania, New Jersey, Delaware) organ procurement organization database, cross-referenced to the Organ Procurement and Transplantation Network database, assessed kidney transplants using donors supported on venoarterial (VA) and venovenous (VV) ECMO for nondonation purposes. Transplants using VA- and VV-ECMO donors were compared with Kidney Donor Profile Index (KDPI)-stratified non-ECMO donors. Regression modeling of the entire ECMO and non-ECMO populations assessed ECMO as predictive of graft survival. Additional regression of the ECMO population alone assessed for donor features associated with graft survival. Results Seventy-eight ECMO donors yielded 128 kidney transplants (VA: 80, VV: 48). Comparing outcomes using these donors to kidney transplants using organs from KDPI-stratified non-ECMO donors, VA- and VV-ECMO donor grafts conferred similar rates of delayed graft function and posttransplant renal function to KDPI-matched non-ECMO counterparts. VA-ECMO kidneys demonstrated superior graft survival compared with the lowest-quality (KDPI 86%-100%) non-ECMO kidneys and similar graft survival to KDPI <85% non-ECMO kidneys. VV-ECMO showed inferior graft survival to all but the lowest-quality (KDPI 86%-100%) non-ECMO kidneys. VV-ECMO, but not VA-ECMO, was associated with increased risk of graft loss on multivariable regression (hazard ratios-VA: 1.02, VV: 2.18). Higher KDPI, advanced age, increased body mass index, hypertension, and diabetes were identified as high-risk features of ECMO donors. Conclusions Kidney transplantation using appropriately selected ECMO donors can safely expand the donor pool. Ongoing studies are necessary to determine best practice patterns using kidneys from these donors.
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Affiliation(s)
| | - Devon J. Pace
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Sage A. Vincent
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ashesh P. Shah
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Jaime M. Glorioso
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Warren R. Maley
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Adam M. Frank
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Carlo B. Ramirez
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Sharon West
- Gift of Life Donor Program, Philadelphia, PA
| | | | - Adam S. Bodzin
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
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van Diepen S, Menon V. The extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock (ECLS-shock) trial in perspective. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:624-626. [PMID: 37643375 DOI: 10.1093/ehjacc/zuad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 St NW, Edmonton AB T6G 2B7, Alberta, Canada
| | - Venu Menon
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
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12
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Herbst N, Javidfar J. The Burden of Survivorship After Venoarterial Extracorporeal Membrane Oxygenation: A Black Box. Crit Care Med 2023; 51:1278-1280. [PMID: 37589522 DOI: 10.1097/ccm.0000000000005948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Nicole Herbst
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University, Atlanta, GA
| | - Jeffrey Javidfar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, GA
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Barssoum K, Patel HP, Abdelmaseih R, Hassib M, Victor V, Mohamed A, Jazar DA, Mai S, Ibrahim F, Patel B, Baeni AE, Khalife W, Bandyopadhay D, Rai D, Chatila K. Characteristics and Outcomes of Early vs Late Initiation of Mechanical Circulatory Support in Non-Acute Myocardial Infarction related Cardiogenic Shock: An Analysis of the National Inpatient Sample Database. Curr Probl Cardiol 2023; 48:101584. [PMID: 36642353 DOI: 10.1016/j.cpcardiol.2023.101584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Cardiogenic shock (CS) is significant cause of mortality. The use of mechanical circulatory support (MCS) in patients with non-acute myocardial infarction (Non-AMI) CS is lacking. We inquired data regarding the trends and outcomes early vs late initiation of MCS in non-AMI CS. We investigated National Inpatient Sample database between October 2015-December 2018, identifying hospitalizations with CS, either complicated by AMI or Non-AMI. Patients were divided into 2 cohorts, early initiation of MCS (<48 hours) and late initiation of MCS (>48 hours). The primary analysis included death within first 24 hours. A secondary analysis was adjusted after excluding patients who died in first 24 hours. A total of 85,318 patients with non-AMI-related CS with MCS placement were identified. Among this cohort, 54.6% (n=46,579) underwent early initiation of MCS within 48 hours, and 45.4% (n=38,739) underwent late initiation of MCS after 48 hours. In primary analysis, early MCS initiation was associated with more in-hospital mortality in primary outcome of all-cause hospital mortality (35.72% vs 27.63%, P<0.0001, OR 1.44, 95% CI: 1.40-1.49, P<0.0001), however, adjusted secondary analysis showed a statistically significant decrease in all-cause hospital mortality (23.63% vs 27.63%, P<0.0001, OR 0.80, 95% CI: 0.78-0.83, P<0.0001). In non-AMI-related CS and based on survival to 24 hours after admission, early initiation of MCS had statistically significant decrease in all-cause hospital mortality, with less incidence of vascular and renal complications, and shorter hospital stay. Late initiation of MCS was associated with a higher incidence of advanced therapies, including LVAD and transplant.
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Affiliation(s)
- Kirolos Barssoum
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | - Harsh P Patel
- Department cardiology, Southern Illinois University, Carbondale, IL
| | - Ramy Abdelmaseih
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | - Mohab Hassib
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | | | - Ahmed Mohamed
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | - Deaa Abu Jazar
- Department of internal medicine, University of Texas Medical Branch, Galveston, TX
| | - Steven Mai
- Department of internal medicine, University of Texas Medical Branch, Galveston, TX
| | - Fadi Ibrahim
- American University of Antigua, Antigua & Barbuda
| | - Bhavin Patel
- Department of internal medicine, Saint Joseph Mercy Oakland Hospital, Pontiac, MI
| | - Aiham El Baeni
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | - Wissam Khalife
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
| | | | - Devesh Rai
- Department of Cardiology, Sands-Constellation Heart Institute, Rochester Regional Health, Rochester, NY.
| | - Khaled Chatila
- Department of cardiology, University of Texas Medical Branch, Galveston, TX
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Cankar T, Krepek M, Kosmopoulos M, Radšel P, Yannopoulos D, Noc M, Goslar T. Long-Term Survival and Quality of Life in Non-Surgical Adult Patients Supported with Veno-Arterial Extracorporeal Oxygenation. J Clin Med 2022; 11:6452. [PMID: 36362678 PMCID: PMC9658568 DOI: 10.3390/jcm11216452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for hemodynamic support is on the rise. Not much is known about the impact of extracorporeal membrane oxygenation (ECMO) and its complications on long-term survival and quality of life. METHODS In this single-center, cross-sectional study, we evaluated the survival and quality of life in patients treated with VA ECMO between May 2009 and July 2019. Follow-up was conducted between November 2019 and January 2020. RESULTS Overall, 118 patients were evaluated in this study. Of the 37 patients who were alive at hospital discharge, 32 answered the EuroQol-5 dimensional-5-level questionnaire (EQ-5D-5L). For patients discharged alive from the hospital, mean survival was 8.1 years, 8.4 years for cardiogenic shock, and 5.0 years for patients with refractory cardiac arrest. EQ-5D-5L index value of ECMO survivors was not significantly different from the general age-matched population. Neurologic complications and major bleeding during index hospitalization limit long-term quality of life. CONCLUSIONS Patients treated with VA ECMO have high in-hospital mortality, with extracorporeal membrane oxygenation cardio-pulmonary resuscitation patients being at higher risk of early death. However, once discharged from the hospital, most patients remain alive with a reasonable quality of life.
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Affiliation(s)
- Tomaž Cankar
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mihela Krepek
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine and Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Peter Radšel
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine and Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Marko Noc
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaž Goslar
- Department of Intensive Internal Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
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