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Ellauzi R, Erdem S, Salam MF, Kumar A, Aggarwal V, Koenig G, Aronow HD, Basir MB. Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism. J Clin Med 2024; 13:3161. [PMID: 38892871 PMCID: PMC11172824 DOI: 10.3390/jcm13113161] [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: 03/18/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management.
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Affiliation(s)
- Rama Ellauzi
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Saliha Erdem
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI 48202, USA;
| | - Mohammad Fahad Salam
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48502, USA;
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, USA;
| | - Vikas Aggarwal
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Gerald Koenig
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Herbert D. Aronow
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Mir Babar Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
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Beaulieu J, Vu C, Kalra S, Chahdi HO, 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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Yuriditsky E, Chonde M, Friedman O, Horowitz JM. Medical and Mechanical Circulatory Support of the Failing Right Ventricle. Curr Cardiol Rep 2024; 26:23-34. [PMID: 38108956 DOI: 10.1007/s11886-023-02012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW To describe medical therapies and mechanical circulatory support devices used in the treatment of acute right ventricular failure. RECENT FINDINGS Experts have proposed several algorithms providing a stepwise approach to medical optimization of acute right ventricular failure including tailored volume administration, ideal vasopressor selection to support coronary perfusion, inotropes to restore contractility, and pulmonary vasodilators to improve afterload. Studies have investigated various percutaneous and surgically implanted right ventricular assist devices in several clinical settings. The initial management of acute right ventricular failure is often guided by invasive hemodynamic data tracking parameters of circulatory function with the use of pharmacologic therapies. Percutaneous microaxial and centrifugal extracorporeal pumps bypass the failing RV and support circulatory function in severe cases of right ventricular failure.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Langone Health, 530 First Ave. Skirball 9R, New York, NY, 10016, USA.
| | - Meshe Chonde
- Department of Cardiology, Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Oren Friedman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - James M Horowitz
- Division of Cardiology, Department of Medicine, NYU Langone Health, 530 First Ave. Skirball 9R, New York, NY, 10016, 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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Groeneveld NTA, Swier CEL, Montero-Cabezas J, Elzo Kraemer CV, Klok FA, van den Brink FS. Mechanical Support Strategies for High-Risk Procedures in the Invasive Cardiac Catheterization Laboratory: A State-of-the-Art Review. J Clin Med 2023; 12:7755. [PMID: 38137824 PMCID: PMC10744085 DOI: 10.3390/jcm12247755] [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: 11/05/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Thanks to advancements in percutaneous cardiac interventions, an expanding patient population now qualifies for treatment through percutaneous endovascular procedures. High-risk interventions far exceed coronary interventions and include transcatheter aortic valve replacement, endovascular management of acute pulmonary embolism and ventricular tachycardia ablation. Given the frequent impairment of ventricular function in these patients, frequently deteriorating during percutaneous interventions, it is hypothesized that mechanical ventricular support may improve periprocedural survival and subsequently patient outcome. In this narrative review, we aimed to provide the relevant evidence found for the clinical use of percutaneous mechanical circulatory support (pMCS). We searched the Pubmed database for articles related to pMCS and to pMCS and invasive cath lab procedures. The articles and their references were evaluated for relevance. We provide an overview of the clinically relevant evidence for intra-aortic balloon pump, Impella, TandemHeart and ECMO and their role as pMCS in high-risk percutaneous coronary intervention, transcatheter valvular procedures, ablations and high-risk pulmonary embolism. We found that the right choice of periprocedural pMCS could provide a solution for the hemodynamic challenges during these procedures. However, to enhance the understanding of the safety and effectiveness of pMCS devices in an often high-risk population, more randomized research is needed.
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Affiliation(s)
- Niels T. A. Groeneveld
- Department of Anesthesiology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Carolien E. L. Swier
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
| | - Jose Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Carlos V. Elzo Kraemer
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
| | - Frederikus A. Klok
- Department of Medicine—Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands;
| | - Floris S. van den Brink
- Department of Intensive Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; (C.E.L.S.); (C.V.E.K.)
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Brewer JM, Broman LM, Swol J, Lorusso R, Conrad SA, Maybauer MO. Standardized nomenclature for peripheral percutaneous cannulation of the pulmonary artery in extracorporeal membrane oxygenation: Current uptake and recommendations for improvement. Perfusion 2023:2676591231210457. [PMID: 37930875 DOI: 10.1177/02676591231210457] [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: 11/08/2023]
Abstract
The rising application of extracorporeal membrane oxygenation (ECMO) has emphasized the need for consistent and standardized terminology, especially concerning peripheral percutaneous cannulation of the pulmonary artery (PPC-PA). The Extracorporeal Life Support Organization (ELSO) Nomenclature Task Force produced the ELSO Maastricht Treaty for extracorporeal life support (ECLS) Nomenclature to address this challenge. However, adherence to nomenclature recommendations has been poor in publications describing PPC-PA. We aim to describe common nomenclature errors and provide a user-guide for abbreviations that can be used by authors, reviewers, and journal staff to ensure properadherence to standardized nomenclature in publications describing PPC-PA.
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Affiliation(s)
- J Michael Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - L Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center, Maastricht (MUMC), The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
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