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Tempe DK. Teamwork in Acute Heart Failure: The Role of the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2023; 37:843-845. [PMID: 36842940 DOI: 10.1053/j.jvca.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Deepak K Tempe
- Department of Anaesthesiology and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India; Professor Emeritus, Cardiac Anaesthesia, National Academy of Medical Sciences, New Delhi, India.
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Rissel R, Koelm S, Schepers M, Dohle DS, Albers J, Oezkur M, Kriege M, Bodenstein M. Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients. PLoS One 2022; 17:e0278139. [PMID: 36441698 PMCID: PMC9704663 DOI: 10.1371/journal.pone.0278139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor.
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Affiliation(s)
- René Rissel
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
- * E-mail:
| | - Sascha Koelm
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Markus Schepers
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Daniel-Sebastian Dohle
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joerg Albers
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiothoracic and Vascular Surgery, University Hospital of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marc Kriege
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Marc Bodenstein
- Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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How effective is extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest? A systematic review and meta-analysis. Am J Emerg Med 2021; 51:127-138. [PMID: 34735971 DOI: 10.1016/j.ajem.2021.08.072] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/17/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) has gained increasing as a promising but resource-intensive intervention for out-of-hospital cardiac arrest (OHCA). There is little data to quantify the impact of this intervention and the patients likely to benefit from its use. We conducted a meta-analysis of the literature to assess the survival benefit associated with ECPR for OHCA. METHODS We searched PubMed, Embase, and Scopus databases to identify relevant observational studies and randomized control trials. We used the Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to assess studies' quality. We performed random-effects meta-analysis for the primary outcome of survival to hospital discharge and used meta-regressions to assess heterogeneity. RESULTS We identified 1287 articles, reviewed the full text of 209 and included 44 in our meta-analysis. Our analysis included 3097 patients with OHCA. Patients' mean age was 52, 79% were male, and 60% had primary ventricular fibrillation/ventricular tachycardia arrest. We identified a survival-to-discharge rate of 24%; 18% survived with favorable neurologic function. 30- and 90-days survival rates were both around 18%. The majority of included articles were high quality studies. CONCLUSIONS Extracorporeal cardiopulmonary resuscitation is a promising but resource-intensive intervention that may increase rates of survival to hospital discharge among patients who experience OHCA.
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Raman J, Musca SC, O'Brien YL. Extracorporeal Membrane Oxygenation (ECMO) - Time is of the Essence! Heart Lung Circ 2021; 30:1433-1434. [PMID: 34384702 DOI: 10.1016/j.hlc.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jaishankar Raman
- Austin & St Vincent's Hospitals, Melbourne University, Melbourne, Vic, Australia; Deakin University, Geelong & Melbourne, Vic, Australia; Oregon Health and Science University, Portland, OR, USA; University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Steven C Musca
- St Vincent's Hospital, Melbourne University, Melbourne, Vic, Australia
| | - Yvette L O'Brien
- St Vincent's Hospital, Melbourne University, Melbourne, Vic, Australia
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Sugimura Y, Mehdiani A, Aubin H, Rellecke P, Boeken U, Lichtenberg A, Akhyari P. Multimodal mechanical circulatory assist for perioperative biventricular failure. J Card Surg 2020; 36:712-715. [PMID: 33283318 DOI: 10.1111/jocs.15198] [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: 09/07/2020] [Revised: 10/13/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
A 61-year-old woman with acute myocardial infarction (MI), cardiogenic shock, and Impella CP support underwent emergency coronary artery bypass grafting. Postoperatively venous-arterial extracorporeal membrane oxygenation (va-ECMO) became necessary, followed by Impella 5.0 insertion on 7th postoperative day (POD), the addition of right ventricular support by TandemHeart due to inadequate flow of Impella system, which then allowed for va-ECMO weaning. Impella und TandemHeart were removed on 14th POD, 31st POD, respectively. Biventricular decompensation following MI was successfully treated by a sequence of different mechanical circulatory support systems allowing an adaptive weaning strategy.
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Affiliation(s)
- Yukiharu Sugimura
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Arash Mehdiani
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Ibrahim M, Spelde AE, Gutsche JT, Cevasco M, Bermudez CA, Desai ND, Szeto WY, Atluri P, Acker MA, Williams ML. Coronary Artery Bypass Grafting in Cardiogenic Shock: Decision-Making, Management Options, and Outcomes. J Cardiothorac Vasc Anesth 2020; 35:2144-2154. [PMID: 33268279 DOI: 10.1053/j.jvca.2020.09.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 11/11/2022]
Abstract
Coronary artery bypass grafting is a highly efficacious mode of myocardial revascularization that reduces mortality from ischemic heart disease. The patient presenting after acute myocardial infarction in cardiogenic shock presents a unique challenge. Early revascularization is proven to reduce mortality, but many questions remain, including the optimal mode and extent of revascularization, the role of mechanical circulatory support, and which patients are candidates for surgical intervention. Unprecedented attention to the outcomes of cardiac surgery means decisions about the management of the acute myocardial infarction in cardiogenic shock patients are influenced by risk aversion. The authors here review this topic to arm the reader with a comprehensive understanding of the literature to better guide surgical decision-making and perioperative management.
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Affiliation(s)
- Michael Ibrahim
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
| | - Audrey E Spelde
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Christian A Bermudez
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Michael A Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Matthew L Williams
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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