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Delmas C, Ughetto A, Lebreton G, Roubille F. Venting strategies for extracorporeal membrane oxygenation patients: More questions than answers but a plea for more clinical trials on the topic! Eur J Heart Fail 2024; 26:1261-1264. [PMID: 37728031 DOI: 10.1002/ejhf.3038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Toulouse University Hospital, Toulouse, France
- Recherche et Enseignement en Insuffisance Cardiaque Avancée, Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, Toulouse, France
| | - Aurore Ughetto
- Anesthesia and Intensive Cardiac Care Unit, Montpellier University Hospital, Montpellier, France
| | - Guillaume Lebreton
- Cardiovascular Surgery Department, La Pitié University Hospital, Paris, France
| | - François Roubille
- Intensive Cardiac Care Unit, Cardiology Department, Montpellier University Hospital, Montpellier, France
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Philip RR, Sentilles C, Johnson JN, Merlocco A, Ramakrishnan K, Ryan KA, Boston U, Sathanandam S. Lessons from the Pandemic: Role of Percutaneous ECMO and Balloon Atrial Septostomy in Multi-System Inflammatory Syndrome in Children. J Clin Med 2024; 13:2168. [PMID: 38673441 PMCID: PMC11050248 DOI: 10.3390/jcm13082168] [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: 02/22/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Multi-system inflammatory syndrome in children (MIS-C) in the setting of COVID-19 can be associated with severe cardiopulmonary dysfunction. This clinical deterioration may sometimes necessitate veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. We describe an algorithmic approach including the role of balloon atrial septostomy in this cohort. This is the first reported series of percutaneous VA-ECMO in pediatric patients with MIS-C for better outcomes. The lessons from this approach can be replicated in other pediatric clinical conditions and adds to the armament of multiple pediatric specialties.
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Affiliation(s)
- Ranjit R. Philip
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA; (J.N.J.); (A.M.); (K.A.R.); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
| | - Claire Sentilles
- Division of General Pediatrics, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA;
| | - Jason N. Johnson
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA; (J.N.J.); (A.M.); (K.A.R.); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
| | - Anthony Merlocco
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA; (J.N.J.); (A.M.); (K.A.R.); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
| | - Karthik Ramakrishnan
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, 901 Madison Ave. Memphis, TN 38163, USA
| | - Kaitlin A. Ryan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA; (J.N.J.); (A.M.); (K.A.R.); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
| | - Umar Boston
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, 901 Madison Ave. Memphis, TN 38163, USA
| | - Shyam Sathanandam
- Division of Pediatric Cardiology, Department of Pediatrics, University of Tennessee Health Science Center, 50 N Dunlap St., Memphis, TN 38103, USA; (J.N.J.); (A.M.); (K.A.R.); (S.S.)
- The Heart Institute, Le Bonheur Children’s Hospital, 51 N Dunlap St., Memphis, TN 38103, USA; (K.R.); (U.B.)
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Ezad SM, Ryan M, Barrett N, Camporota L, Swol J, Antonini MV, Donker DW, Pappalardo F, Kapur NK, Rose L, Perera D. Left ventricular unloading in patients supported with veno-arterial extra corporeal membrane oxygenation; an international EuroELSO survey. Perfusion 2024; 39:13S-22S. [PMID: 38651575 DOI: 10.1177/02676591241229647] [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] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid cardiac recovery and prevent complications of increased afterload. However, there is no consensus on when and which unloading strategy should be used. METHODS An online survey was distributed worldwide via the EuroELSO newsletter mailing list to describe contemporary international practice and evaluate heterogeneity in strategies for LV unloading. RESULTS Of 192 respondents from 43 countries, 53% routinely use mechanical LV unloading, to promote ventricular recovery and/or to prevent complications. Of those that do not routinely unload, 65% cited risk of complications as the reason. The most common indications for unplanned unloading were reduced arterial line pulsatility (68%), pulmonary edema (64%) and LV dilatation (50%). An intra-aortic balloon pump was the most frequently used device for unloading followed by percutaneous left ventricular assist devices. Echocardiography was the most frequently used method to monitor the response to unloading. CONCLUSIONS Significant variation exists with respect to international practice of ventricular unloading. Further research is required that compares the efficacy of different unloading strategies and a randomized comparison of routine mechanical unloading versus unplanned unloading.
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Affiliation(s)
- Saad M Ezad
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
| | - Nicholas Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | - Marta V Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USA
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Division of Applied Technologies for Clinical Care, King's College London, London, UK
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, UK
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Koziol KJ, Isath A, Rao S, Gregory V, Ohira S, Van Diepen S, Lorusso R, Krittanawong C. Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock. J Clin Med 2023; 12:5576. [PMID: 37685643 PMCID: PMC10488419 DOI: 10.3390/jcm12175576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Cardiogenic shock is a critical condition of low cardiac output resulting in insufficient systemic perfusion and end-organ dysfunction. Though significant advances have been achieved in reperfusion therapy and mechanical circulatory support, cardiogenic shock continues to be a life-threatening condition associated with a high rate of complications and excessively high patient mortality, reported to be between 35% and 50%. Extracorporeal membrane oxygenation can provide full cardiopulmonary support, has been increasingly used in the last two decades, and can be used to restore systemic end-organ hypoperfusion. However, a paucity of randomized controlled trials in combination with high complication and mortality rates suggest the need for more research to better define its efficacy, safety, and optimal patient selection. In this review, we provide an updated review on VA-ECMO, with an emphasis on its application in cardiogenic shock, including indications and contraindications, expected hemodynamic and echocardiographic findings, recommendations for weaning, complications, and outcomes. Furthermore, specific emphasis will be devoted to the two published randomized controlled trials recently presented in this setting.
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Affiliation(s)
- Klaudia J. Koziol
- School of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Ameesh Isath
- Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Shiavax Rao
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Vasiliki Gregory
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Sean Van Diepen
- Division of Cardiology and Critical Care, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, 6202 AZ Maastricht, The Netherlands
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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Ezad SM, Ryan M, Donker DW, Pappalardo F, Barrett N, Camporota L, Price S, Kapur NK, Perera D. Unloading the Left Ventricle in Venoarterial ECMO: In Whom, When, and How? Circulation 2023; 147:1237-1250. [PMID: 37068133 PMCID: PMC10217772 DOI: 10.1161/circulationaha.122.062371] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 04/19/2023]
Abstract
Venoarterial extracorporeal membrane oxygenation provides cardiorespiratory support to patients in cardiogenic shock. This comes at the cost of increased left ventricle (LV) afterload that can be partly ascribed to retrograde aortic flow, causing LV distension, and leads to complications including cardiac thrombi, arrhythmias, and pulmonary edema. LV unloading can be achieved by using an additional circulatory support device to mitigate the adverse effects of mechanical overload that may increase the likelihood of myocardial recovery. Observational data suggest that these strategies may improve outcomes, but in whom, when, and how LV unloading should be employed is unclear; all techniques require balancing presumed benefits against known risks of device-related complications. This review summarizes the current evidence related to LV unloading with venoarterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Saad M Ezad
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Matthew Ryan
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
| | - Dirk W Donker
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cardiovascular & Respiratory Physiology (CRPH), University of Twente, Enschede, The Netherlands
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Nicholas Barrett
- Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Susanna Price
- Departments of Critical Care & Cardiology, Royal Brompton & Harefield Hospitals, London, UK
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Divaka Perera
- British Heart Foundation Centre of Research Excellence and NIHR Biomedical Research Centre at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
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Zhou L, Sun J, Yang T, Wang S, Shan T, Gu L, Chen J, Wei T, Zhao D, Du C, Bao Y, Wang H, Lu X, Sun H, Lv M, Yang D, Wang L. Improved methodology for efficient establishment of the myocardial ischemia-reperfusion model in pigs through the median thoracic incision. J Biomed Res 2023:1-11. [PMID: 37088562 PMCID: PMC10387751 DOI: 10.7555/jbr.36.20220189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
To investigate the feasibility and effectiveness of establishing porcine ischemia-reperfusion models by ligating the left anterior descending (LAD) coronary artery, we first randomly divided 16 male Bama pigs into a sham group and a model group. After anesthesia, we separated the arteries and veins. Subsequently, we rapidly located the LAD coronary artery at the beginning of its first diagonal branch through a mid-chest incision. Then, we loosened and released the ligation line after five minutes of pre-occlusion. Finally, we ligated the LAD coronary artery in situ two minutes later and loosened the ligature 60 min after ischemia. Compared with the sham group, electrocardiogram showed multiple continuous lead ST-segment elevations, and ultrasound cardiogram showed significantly lower ejection fraction and left ventricular fractional shortening at one hour and seven days post-operation in the model group. Twenty-four hours after the operation, cardiac troponin T and creatine kinase-MB isoenzyme levels significantly increased in the model group, compared with the sham group. Hematoxylin and eosin staining showed the presence of many inflammatory cells infiltrating the interstitium of the myocardium in the model group but not in the sham group. Masson staining revealed a significant increase in infarct size in the ischemia/reperfusion group. All eight pigs in the model group recovered with normal sinus heart rates, and the survival rate was 100%. In conclusion, the method can provide an accurate and stable large animal model for preclinical research on ischemia/reperfusion with a high success rate and homogeneity of the myocardial infarction area.
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Affiliation(s)
- Liuhua Zhou
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jiateng Sun
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tongtong Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Sibo Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tiankai Shan
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Lingfeng Gu
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Jiawen Chen
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Tianwen Wei
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Di Zhao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chong Du
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yulin Bao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hao Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Xiaohu Lu
- Department of Cardiac surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Haoliang Sun
- Department of Cardiac surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Meng Lv
- Medical Experimental Animal Center, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Di Yang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Liansheng Wang
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
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KITTNAR O. Ten years of our translational research in the field of veno-arterial extracorporeal membrane oxygenation. Physiol Res 2022; 71:S163-S178. [PMID: 36647905 PMCID: PMC9906662 DOI: 10.33549/physiolres.934999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Extracorporeal life support is a treatment modality that provides prolonged blood circulation, gas exchange and can substitute functions of heart and lungs to provide urgent cardio-respiratory stabilization in patients with severe but potentially reversible cardiopulmonary failure refractory to conventional therapy. Generally, the therapy targets blood pressure, volume status, and end-organs perfusion. As there are significant differences in hemodynamic efficacy among different percutaneous circulatory support systems, it should be carefully considered when selecting the most appropriate circulatory support for specific medical conditions in individual patients. Despite severe metabolic and hemodynamic deterioration during prolonged cardiac arrest, venoarterial extracorporeal membrane oxygenation (VA ECMO) can rapidly revert otherwise fatal prognosis, thus carrying a potential for improvement in survival rate, which can be even improved by introduction of mild therapeutic hypothermia. In order to allow a rapid transfer of knowledge to clinical medicine two porcine models were developed for studying efficiency of the VA ECMO in treatments of acute cardiogenic shock and progressive chronic heart failure. These models allowed also an intensive research of adverse events accompanying a clinical use of VA ECMO and their possible compensations. The results indicated that in order to weaken the negative effects of increased afterload on the left ventricular function the optimal VA ECMO flow in cardiogenic shock should be as low as possible to allow adequate tissue perfusion. The left ventricle can be also unloaded by an ECG-synchronized pulsatile flow if using a novel pulsatile ECMO system. Thus, pulsatility of VA ECMO flow may improve coronary perfusion even under conditions of high ECMO blood flows. And last but not least, also the percutaneous balloon atrial septostomy is a very perspective method how to passively decompress overloaded left heart.
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Affiliation(s)
- Otomar KITTNAR
- Institute of Physiology of the First Faculty of Medicine, Charles University, Prague, Czech Republic
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Ostadal P, Vondrakova D, Popkova M, Hrachovina M, Kruger A, Janotka M, Naar J, Kittnar O, Neuzil P, Mlcek M. Aortic stenosis and mitral regurgitation modify the effect of venoarterial extracorporeal membrane oxygenation on left ventricular function in cardiogenic shock. Sci Rep 2022; 12:17076. [PMID: 36224296 PMCID: PMC9556561 DOI: 10.1038/s41598-022-21501-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/28/2022] [Indexed: 01/04/2023] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in the treatment of patients experiencing cardiogenic shock (CS). However, increased VA-ECMO blood flow (EBF) may significantly impair left ventricular (LV) performance. The objective of the present study was to assess the effect of VA-ECMO on LV function in acute CS with concomitant severe aortic stenosis (AS) or mitral regurgitation (MR) in a porcine model. Eight female swine (45 kg) underwent VA-ECMO implantation under general anaesthesia and mechanical ventilation. Acute CS was induced by global myocardial hypoxia. Subsequently, severe AS was simulated by obstruction of the aortic valve, while severe MR was induced by mechanical destruction of the mitral valve. Haemodynamic and LV performance variables were measured at different rates of EBF rates (ranging from 1 to 4 L/min), using arterial and venous catheters, a pulmonary artery catheter, and LV pressure-volume catheter. Data are expressed as median (interquartile range). Myocardial hypoxia resulted in declines in cardiac output to 2.7 (1.9-3.1) L/min and LV ejection fraction to 15.2% (10.5-19.3%). In severe AS, increasing EBF from 1 to 4 L/min was associated with a significant elevation in mean arterial pressure (MAP), from 33.5 (24.2-34.9) to 56.0 (51.9-73.3) mmHg (P ˂ 0.01). However, LV volumes (end-diastolic, end-systolic, stroke) remained unchanged, and LV end-diastolic pressure (LVEDP) significantly decreased from 24.9 (21.2-40.0) to 19.1 (15.2-29.0) mmHg (P ˂ 0.01). In severe MR, increasing EBF resulted in a significant elevation in MAP from 49.0 (28.0-53.4) to 72.5 (51.4-77.1) mmHg (P ˂ 0.01); LV volumes remained stable and LVEDP increased from 17.1 (13.7-19.1) to 20.8 (16.3-25.6) mmHg (P ˂ 0.01). Results of this study indicate that the presence of valvular heart disease may alleviate negative effect of VA-ECMO on LV performance in CS. Severe AS fully protected against LV overload, and partial protection was also detected with severe MR, although at the cost of increased LVEDP and, thus, higher risk for pulmonary oedema.
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Affiliation(s)
- Petr Ostadal
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Dagmar Vondrakova
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Michaela Popkova
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Matej Hrachovina
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Andreas Kruger
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Marek Janotka
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Jan Naar
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Otomar Kittnar
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Petr Neuzil
- grid.414877.90000 0004 0609 2583Cardiovascular Center, Na Homolce Hospital, Roentgenova 2, 15000 Prague, Czech Republic
| | - Mikulas Mlcek
- grid.4491.80000 0004 1937 116XDepartment of Physiology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock. J Clin Med 2022; 11:jcm11051256. [PMID: 35268347 PMCID: PMC8910965 DOI: 10.3390/jcm11051256] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/18/2022] Open
Abstract
Mortality in infarct-related cardiogenic shock (CS) remains high, reaching 40–50%. In refractory CS, active mechanical circulatory support devices including veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are rapidly evolving. However, supporting evidence of VA-ECMO therapy in infarct-related CS is low. The current review aims to give an overview on the basics of VA-ECMO therapy, current evidence, ongoing trials, patient selection and potential complications.
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10
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Atrial Septostomy for Left Ventricular Unloading. JACC Cardiovasc Interv 2021; 14:2708-2710. [PMID: 34949395 DOI: 10.1016/j.jcin.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
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