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Beaulieu J, Vu C, Kalra S, Ouazani Chahdi H, Cousineau J, Matteau A, Mansour S, Jolicoeur EM, Jacques S, Nauche B, Podbielski R, Ferraro P, Poirier C, Potter BJ. Right Ventricular Assist Device With an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review. Can J Cardiol 2024:S0828-282X(24)00301-5. [PMID: 38604337 DOI: 10.1016/j.cjca.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure. METHODS PubMed, Embase, and Google Scholar were queried on September 27, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to intensive care unit (ICU) discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded. RESULTS Out of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports, and 12 were case series, representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were moved to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was 12 days (interquartile range 8-23 days), and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported. CONCLUSION OxyRVAD support is a promising alternative for RV support when gas exchange is compromised, with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
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Affiliation(s)
- Juliette Beaulieu
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Christine Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sanjog Kalra
- Interventional Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | | | - Julie Cousineau
- Intensive Care Medicine, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Alexis Matteau
- CHUM Research Center, Montréal, Québec, Canada; Interventional Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Cardiac Intensive Care Unit, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Samer Mansour
- CHUM Research Center, Montréal, Québec, Canada; Interventional Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Cardiac Intensive Care Unit, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - E Marc Jolicoeur
- CHUM Research Center, Montréal, Québec, Canada; Interventional Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Cardiac Intensive Care Unit, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sabrina Jacques
- Clinical Perfusion Service, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bénédicte Nauche
- Bibliothèque du Centre Hospitalier de l'Université de Montréal, Direction de l'Enseignement et de l'Académie Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Renata Podbielski
- Bibliothèque du Centre Hospitalier de l'Université de Montréal, Direction de l'Enseignement et de l'Académie Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pasquale Ferraro
- CHUM Research Center, Montréal, Québec, Canada; Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Lung Transplant Program, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Charles Poirier
- CHUM Research Center, Montréal, Québec, Canada; Lung Transplant Program, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Respirology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Brian J Potter
- CHUM Research Center, Montréal, Québec, Canada; Interventional Cardiology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Cardiac Intensive Care Unit, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:1483-1489. [PMID: 36469447 DOI: 10.1097/mat.0000000000001692] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Right heart failure (RHF) is a common, yet difficult to manage, complication of severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) that is associated with increased mortality. Reports of the use of percutaneous mechanical circulatory support devices for concurrent right heart and respiratory failure are limited. This series describes the percutaneous cannulation of the pulmonary artery for conversion from veno-venous to veno-pulmonary artery return ECMO in 21 patients who developed secondary RHF. All patients cannulated between May 2019 and September 2021 were included. Either a 19 or 21 French venous cannula was placed percutaneously into the pulmonary artery via the internal jugular or subclavian vein, providing a total of 821 days of support (median 23 [4-71] days per patient) with flows up to 6 L/min. Five patients underwent cannulation at the bedside, with the remainder performed in the cardiac catheterization laboratory. Pulmonary artery cannulation occurred after 12 [8.5-23.5] days of ECMO support. Vasoactive infusion requirements decreased significantly within 24 hours of pulmonary artery cannula placement (p = 0.0004). Nonetheless, 75% of these patients expired after a median of 12 [4-63] days of support, with three patients found to have had significant pericardial effusions peri-arrest. This cannulation technique may be an effective alternative to veno-arterial ECMO cannulation or the placement of a dual-lumen cannula for the treatment of RHF.
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Volfson B, Balabanoff Acosta CS, Louro J. Use of single-cannula extracorporeal membrane oxygenation in the pulmonary artery to provide right heart support during respiratory failure in a drowning victim. Int J Crit Illn Inj Sci 2021; 11:102-105. [PMID: 34395213 PMCID: PMC8318173 DOI: 10.4103/ijciis.ijciis_68_20] [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: 05/12/2020] [Revised: 08/14/2020] [Accepted: 09/11/2020] [Indexed: 11/04/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) and respiratory failure can occur after drowning. Some of these patients do not respond to conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). Patients with severe respiratory failure can also develop acute right heart failure. We describe a case of a young drowning victim who developed ARDS and subsequent right heart failure. The patient was initiated on venovenous ECMO with right atrial to pulmonary artery cannulation of ECMO using the Protek Duo (TandemLife, Pittsburgh, PA, USA). The patient recovered from his ARDS and heart failure and was successfully liberated from ECMO. We will discuss the utility of ECMO in drowning victims and the use of this unique cannulation strategy to support the right ventricle in patients with concomitant respiratory failure.
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Affiliation(s)
- Boris Volfson
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson, Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Christian S Balabanoff Acosta
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson, Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Jack Louro
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Anesthesiology, Perioperative Medicine and Pain Management, Ryder Trauma Center, Jackson Health System, Miami, FL, USA
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Vijayakumar N, Badheka A, Chegondi M, Mclennan D. Successful use of Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricular support for acute respiratory distress syndrome in an adolescent with complex congenital heart disease. Perfusion 2020; 36:200-203. [DOI: 10.1177/0267659120923880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rescuing patients with the development of acute respiratory distress syndrome and right heart failure after left ventricular assist device placement remains a challenge in patients with congenital heart disease. TandemLife Protek Duo (TandemLife, Pittsburg, PA) is a double-lumen cannula introduced via the internal jugular vein that can provide veno-venous extra-corporeal membrane oxygenation and right heart support. To our knowledge, we report the first case of successfully using the TandemLife Protek Duo cannula to provide veno-venous extra-corporeal membrane oxygenation and right ventricle support in an adolescent male with an existing right ventricle-pulmonary artery conduit and the melody pulmonary valve who developed severe acute respiratory distress syndrome after the placement of left ventricular assist device. The stability of the cannula enabled minimal recirculation-related hypoxia events, early mobilization, and ambulation. Our patient was discharged home after lung recovery and currently awaiting a heart transplant.
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Affiliation(s)
- Niranjan Vijayakumar
- Division of Critical Care, Department of Pediatrics, Stead Family Children’s Hospital, The University of Iowa, Iowa City, IA, USA
| | - Aditya Badheka
- Division of Critical Care, Department of Pediatrics, Stead Family Children’s Hospital, The University of Iowa, Iowa City, IA, USA
| | - Madhuradhar Chegondi
- Division of Critical Care, Department of Pediatrics, Stead Family Children’s Hospital, The University of Iowa, Iowa City, IA, USA
| | - Daniel Mclennan
- Division of Cardiology, Department of Pediatrics, Stead Family Children’s Hospital, The University of Iowa, Iowa City, IA, USA
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Grant C, Richards JB, Frakes M, Cohen J, Wilcox SR. ECMO and Right Ventricular Failure: Review of the Literature. J Intensive Care Med 2020; 36:352-360. [PMID: 31964208 DOI: 10.1177/0885066619900503] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Right ventricular (RV) failure is the inability of the RV to maintain sufficient cardiac output in the setting of adequate preload, due to either intrinsic injury to the RV or increased afterload. Medical treatment of RV failure should include optimizing preload, augmenting contractility with vasopressors and inotropes, and considering inhaled pulmonary vasodilators. However, when medical therapies are insufficient, mechanical circulatory support (MCS) is needed to maintain systemic and RV perfusion. The data on MCS for isolated RV failure are limited, but extracorporeal membrane oxygenation (ECMO) appears to be the most efficient and effective modality. For patients with isolated RV failure from acute hypoxemic respiratory failure, veno-venous (VV) ECMO is an appropriate initial configuration, even if the patient is in shock. With primary RV injury or RV failure with concomitant left ventricle (LV) failure, however, venoarterial (VA) ECMO is indicated. Both modalities provide indirect support to the RV by reducing preload, reducing RV wall tension, and delivering oxygenated blood to the coronary circulation. Peripheral cannulation is required in VV-ECMO and is most commonly used in VA-ECMO, allowing for rapid cannulation even in emergencies. Changes in pulsatility on an arterial catheter waveform can indicate changes in clinical status including changes in myocardial function, inadequate preload, worsening RV failure, and excessive VA-ECMO support leading to an elevated LV afterload. Myocardial function may be improved by titration of inotropes or vasodilators, utilization of an Impella or an intra-aortic balloon counterpulsation support devices, or by changes in VA-ECMO support.
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Affiliation(s)
| | - Jeremy B Richards
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jason Cohen
- 485798Boston MedFlight, Bedford, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Susan R Wilcox
- 485798Boston MedFlight, Bedford, MA, USA.,Department of Emergency Medicine, Heart Center ICU, 2348Massachusetts General Hospital, Boston, MA, USA
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