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Benseghir Y, Sebestyan A, Durand M, Bennani F, Bédague D, Chavanon O. [ECMO for post cardiotomy refractory cardiogenic shock: Experience of the cardiac surgery department of the Grenoble Alpes University Hospital]. Ann Cardiol Angeiol (Paris) 2021; 70:63-67. [PMID: 33640147 DOI: 10.1016/j.ancard.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of our study is to detail our experience relating to ECMO implantations for post-cardiotomy refractory shock, by analyzing the pre-ECMO factors (history, type of surgery, LVEF), factors relating to ECMO (implantation time, duration) and post-ECMO factors (weaning, complications) in order to highlight those possibly associated with high mortality. METHODS This is a univariate and multivariate retrospective study of ECMO data implemented between 2011 and 2019 at the Grenoble Alpes University Hospital Center following cardiac surgery. The time to implantation of ECMO was less than 3hours (intraoperative) between 3 and 24hours (early postoperative) and between 24 and 48hours after aortic unclamping (late postoperative). Preoperative or postoperative intra-aortic balloon counterpulsation (CPBIA) could be associated. RESULTS 114 veino-arterial ECMOs were implanted for refractory cardiogenic shock after 5702 cardiac surgeries (1.9%) with a survival rate of 30.7%. The mean age of the patients was 68.6+- 10.5 years. The implantation of ECMO was performed intraoperatively in 71 patients (62.2%), early postoperatively in 22 patients (19.2%) and late postoperatively in 21 patients (18.4%). The duration of assistance was less than 48hours in 27 patients (23.6%), between 48hours and one week in 58 patients (50.9%) and more than one week in 29 patients (25.5%). Univariate analysis revealed a statistically significant association between mortality rate and male sex (P=0.002), association absent with other preoperative characteristics, delay in implantation of ECMO, installation of CPBIA, post-operative characteristics and resuscitation suites. Multivariate analysis of the entire study population demonstrated that the use of ECMO for cardio-respiratory arrest was the only independent risk factor for mortality (OR=7.57 [1.41-40, 62]). After multivariate reanalysis excluding patients with ECMO placement for cardio respiratory arrest, age, preoperative renal failure, type of procedure and EuroSCORE II were risk factors for mortality. CONCLUSION In this study, male gender, type of intervention, occurrence of cardiac arrest were significantly associated with the death rate. A study of greater power, multicentric, and with a larger sample, will have to be carried out to reach significance.
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Affiliation(s)
- Y Benseghir
- Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France.
| | - A Sebestyan
- Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France
| | - M Durand
- Réanimation cardio-vasculaire et thoracique, Pôle anesthésie-réanimation - CHU Grenoble Alpes, Grenoble, France
| | - F Bennani
- Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France
| | - D Bédague
- Réanimation cardio-vasculaire et thoracique, Pôle anesthésie-réanimation - CHU Grenoble Alpes, Grenoble, France
| | - O Chavanon
- Service de chirurgie cardiaque, Pôle thorax-vaisseaux - CHU Grenoble Alpes, Grenoble, France
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Henry P, Lamhaut L, Delmas C, Belle L. Can we still die from acute myocardial infarction in 2020? Reflex mobile cardiac assistance unit or local team for ECMO implantation? Arch Cardiovasc Dis 2019; 112:733-7. [PMID: 31708439 DOI: 10.1016/j.acvd.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
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Helleu B, Auffret V, Bedossa M, Gilard M, Letocart V, Chassaing S, Angoulvant D, Commeau P, Range G, Prunier F, Sabatier R, Filippi E, Delaunay R, Boulmier D, Le Breton H, Leurent G. Current indications for the intra-aortic balloon pump: The CP-GARO registry. Arch Cardiovasc Dis 2018; 111:739-748. [PMID: 29908713 DOI: 10.1016/j.acvd.2018.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/08/2018] [Accepted: 03/21/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intra-aortic balloon pumps (IABPs) have been used routinely since the 1970s. Recently, large randomized trials failed to show that IABP therapy has meaningful benefit, and international recommendations downgraded its place, particularly in cardiogenic shock. AIMS The aim of this registry was to describe the contemporary use of IABP therapy, in light of these new data. METHODS This prospective multicentre registry included 172 patients implanted with an IABP in 19 French cardiac centres in 2015. Baseline characteristics, aetiologies leading to IABP use, and IABP-related and disease-related complications were assessed. In-hospital and 1-year mortality rates were studied. RESULTS A total of 172 patients were included (mean age 65.5±12.0 years; 118 men [68.6%]). The reasons for IABP implantation were mainly haemodynamic (n=107; 62.2%), followed by bridge to revascularization (n=34; 19.8%) and four other "rare" aetiologies (n=29 patients; 16.8%). In-hospital and 1-year mortality rates were 40.7% and 45.8%, respectively. Fourteen patients (8.1%) experienced ischaemic or haemorrhagic complications, which were directly related to the IABP in seven patients (4.1%). CONCLUSIONS Despite current international guidelines regarding the place of IABPs in ischaemic cardiogenic shock without mechanical complications, this aetiology remains the leading cause for its utilization in the contemporary era.
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Affiliation(s)
- Benoit Helleu
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Vincent Auffret
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Marc Bedossa
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France
| | - Martine Gilard
- EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France
| | - Vincent Letocart
- L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Stephan Chassaing
- Service de cardiologie interventionnelle et d'imagerie cardiaque, clinique Saint-Gatien, 37000 Tours, France
| | - Denis Angoulvant
- EA 4245 and Loire Valley Cardiovascular Collaboration, Service de Cardiologie, CHRU de Tours et Université de Tours, 37000 Tours, France
| | - Philippe Commeau
- Service de cardiologie, polyclinique les Fleurs, 83190 Ollioules, France
| | - Grégoire Range
- Service de cardiologie, Les hôpitaux de Chartres, 28000 Chartres, France
| | - Fabrice Prunier
- Institut Mitovasc, UMR CNRS 6015 - INSERM U1083, Service de cardiologie, CHU d'Angers, Université d'Angers, 49100 Angers, France
| | - Remi Sabatier
- Cardiology Department, University Hospital of Caen, 14033 Caen, France
| | - Emmanuelle Filippi
- Service de cardiologie, centre hospitalier de Vannes, 56000 Vannes, France
| | - Régis Delaunay
- Service de cardiologie, centre hospitalier de Saint-Brieuc, 22000 Saint-Brieuc, France
| | - Dominique Boulmier
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Hervé Le Breton
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France
| | - Guillaume Leurent
- Université Rennes, Department of cardiology, CHU Rennes, Inserm, LTSI-UMR 1099, 35000 Rennes, France; EA4324, département de cardiologie, optimisation des régulations physiologiques (ORPhy), UFR sciences et techniques, CHU de Brest, 29200 Brest, France; L'institut du Thorax, CHU Nantes, service de cardiologie, 44093 Nantes, France.
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Spaulding C. [Mechanical cardiac-assist devices in ST segment elevation myocardial infarction]. Ann Cardiol Angeiol (Paris) 2015; 64:513-6. [PMID: 26482626 DOI: 10.1016/j.ancard.2015.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 49-year-old woman was admitted for an anterior ST segment elevation myocardial infarction (STEMI). At hospital arrival, she presented with cardiogenic shock. An immediate coronary angiogram showed an occluded ostial left anterior descending artery. During percutaneous coronary intervention (PCI), ventricular fibrillation occurred requiring multiple electrical counter-shocks. The coronary artery was opened during cardiopulmonary resuscitation and two drug-eluting stents were implanted. At the end of the procedure, an Impella CP® mechanical cardiac-assist device was inserted. Rapid and marked improvement in the hemodynamic status was noted in the following days. The Impella CP® was withdrawn after five days and the patient was discharged two weeks later. Despite limited data, mechanical cardiac assistance is recommended in cardiogenic shock. Several devices are currently available; the choice of the system is based on the clinical presentation and the experience of each center. The Impella CP® is a microaxial pump which is inserted percutaneously and delivers up to 3.5L/min of continuous flow. In cardiogenic shock due to STEMI, this device allows temporary support while awaiting left ventricular recovery after primary PCI.
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D'agrosa-Boiteux MC, Geoffroy E, Dauphin N, Camilleri L, Eschalier R, Cuenin C, Moisa A. [Left ventricle assist device: rehabilitation and management programmes]. Ann Cardiol Angeiol (Paris) 2014; 63:245-252. [PMID: 24768579 DOI: 10.1016/j.ancard.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
Progress in the medical management of patients with heart failure with systolic dysfunction has been accompanied by a significant improvement in survival and quality of life. These strategies have also resulted in changes in the clinical profile as well as an increase in the number of patients with advanced heart failure. The technological developments in left ventricular assist devices provide real hope for these patients. This article related our experience of management and the rehabilitation program realized.
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Affiliation(s)
| | - E Geoffroy
- Service de chirurgie cardiaque, hôpital G.-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France
| | - N Dauphin
- Service de chirurgie cardiaque, hôpital G.-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France
| | - L Camilleri
- Service de chirurgie cardiaque, hôpital G.-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France
| | - R Eschalier
- Service de cardiologie, hôpital G.-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Cuenin
- Clinique de cardiopneumologie, 8, avenue de la Paix, 63830 Durtol, France
| | - A Moisa
- Clinique de cardiopneumologie, 8, avenue de la Paix, 63830 Durtol, France
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Rozec B, Boissier E, Godier A, Cinotti R, Stephan F, Blanloeil Y. [Argatroban, a new antithrombotic treatment for heparin-induced thrombocytopenia application in cardiac surgery and in intensive care]. ACTA ACUST UNITED AC 2014; 33:514-23. [PMID: 25148720 DOI: 10.1016/j.annfar.2014.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/27/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although heparin-induced thrombocytopemia (HIT) is uncommon, its thromboembolic complications are potentially life-threatening. The low-molecular weight heparins are less responsible of HIT than unfractionated heparin (UFH) but this latter is still indicated in some circumstances such as cardiac surgery. Argatroban, a selective thrombin inhibitor, recently available, has been indicated in HIT treatment. This review presents the main pharmacological characteristics, its indications and uses in the context of cardiac surgery and in intensive care medicine. METHODS Review of the literature in Medline database over the past 15 years using the following keywords: argatroban, cardiac surgery, circulatory assistance, cardiopulmonary bypass. RESULTS Despite its short-acting pharmacokinetic, argatroban cannot be recommended during cardiopulmonary bypass. On the contrary, argatroban is indicated in many circumstances in postoperative period of various cardiac surgeries (on-pump, off-pump, circulatory assistance). Nevertheless, after cardiac surgery, doses have to be adapted according to coagulation laboratory testing (ACT), particularly in patients presenting acute organ failure (kidney injury, heart failure, liver failure). This compound has no antagonist and is excluded during severe hepatic failure. The continuous intravenous administration is a drawback. CONCLUSION Argatroban is a new direct competitive thrombin inhibitor well evaluated as treatment of HIT after cardiac surgery. In HIT management, argatroban is an interesting alternative to lepirudin that is not anymore available and danaparoid because of supply disturbances.
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Affiliation(s)
- B Rozec
- Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
| | - E Boissier
- Laboratoire d'hématologie, CHU de Nantes, 44093 Nantes cedex 1, France
| | - A Godier
- Service d'anesthésie et de réanimation chirurgicale, groupe hospitalier Cochin-Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - R Cinotti
- Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
| | - F Stephan
- Réanimation adultes, centre chirurgicale Marie-Lannelongue, 92350 Le Plessis-Robinson, France
| | - Y Blanloeil
- Service d'anesthésie et de réanimation chirurgicale, hôpital G-et-R-Laënnec, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France
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Isetta C, Lebreton G, Janot N, Prommenschenkel M, Rilos Z, Roques F, Longrois D. [Veno-venous extracorporeal oxygenation and veno-arterial extracorporeal oxygenation. Questions, answers]. ACTA ACUST UNITED AC 2014; 33 Suppl 1:S14-22. [PMID: 24630169 DOI: 10.1016/j.annfar.2014.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
Abstract
A round table, organized by the French Society of Perfusion (Sofraperf) at the French national congress on extracorporeal circulations (Perfusion 2013), was attended by perfusionists, anaesthesiologists, intensivists and surgeons around the theme of respiratory veno-venous support and veno-arterial circulatory support with extracorporeal oxygenation in intensive care units. The debate was conducted in a participatory manner by bi-directional questions-answers session between moderators and assistance. The authors report management of this type of therapy that is not perfectly homogeneous, supported on literature data. Cannulae, cannulation, circuit, oxygenator, anticoagulation, control, surveillance, weaning are subject to paragraphs with defined entry whose contents are mutually enriching.
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Affiliation(s)
- C Isetta
- Unité d'anesthésie réanimation en chirurgie cardio-vasculaire-thoracique et bloc d'exploration cardiaque invasive, hôpital Pierre Zobda-Quitman, CHU de la Martinique, quartier La Meynard, 97261 Fort-de-France cedex, Martinique.
| | - G Lebreton
- CHU groupe hospitalier de la Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83 boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - N Janot
- Service de chirurgie cardio-vasculaire et thoracique, hôpital Pierre Zobda-Quitman, CHU de la Martinique, quartier La Meynard, 97261 Fort-de-France cedex, Martinique
| | - M Prommenschenkel
- Unité d'anesthésie réanimation en chirurgie cardio-vasculaire-thoracique et bloc d'exploration cardiaque invasive, hôpital Pierre Zobda-Quitman, CHU de la Martinique, quartier La Meynard, 97261 Fort-de-France cedex, Martinique
| | - Z Rilos
- Service de chirurgie cardio-vasculaire et thoracique, hôpital Pierre Zobda-Quitman, CHU de la Martinique, quartier La Meynard, 97261 Fort-de-France cedex, Martinique
| | - F Roques
- Service de chirurgie cardio-vasculaire et thoracique, hôpital Pierre Zobda-Quitman, CHU de la Martinique, quartier La Meynard, 97261 Fort-de-France cedex, Martinique
| | - D Longrois
- CHU groupe hospitalier HUPNVS, hôpital Bichat-Claude Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henry-Huchard, 75877 Paris cedex 18, France
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