Experimental Venoarterial Extracorporeal Membrane Oxygenation Induces Left Ventricular Dysfunction

Schiller, Petter; Vikholm, Per; Hellgren, Laila

doi:10.1097/mat.0000000000000392

Cited by 37 publications

(30 citation statements)

References 24 publications

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“…VA-ECMO therapy by design leads to an increase in the afterload [6, 7], which might have a negative effect on left ventricular (LV) performance [8] and can increase LV and atrial filling pressures, pulmonary edema, LV distension, or even stasis in the pulmonary circulation [9, 10]. Because of lethal complications in case of clotting, stasis in pulmonary circulation and the left cardiac chambers has to be avoided [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience

et al. 2019

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Background Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients. Methods Analysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy. Results A total of 231 patients (age 58.6 ± 14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24 h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p = 0.034/p = 0.005) and cumulative incidence of in-hospital death (p = 0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p = 0.011) as well as after propensity score matching (OR 0.24, p = 0.037). We found no significant differences between patients with inodilator treatment and those without. Conclusion Early epinephrine therapy within the first 24 h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.

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Section: Introductionmentioning

confidence: 99%

Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience

et al. 2019

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“…The nature of cardiac failure (ie, isolated left, vs isolated right, vs biventricular heart failure) was not incorporated into this model. Since ECMO may hamper left ventricular unloading and worsen left ventricular pressure/volume relations, the presence of predominant left ventricular failure in patients on va‐ECMO support may be associated with worse outcome. To study this hypothesis, we investigated outcome according to the presence of isolated left, vs isolated right, vs biventricular heart failure.…”

Section: Introductionmentioning

confidence: 99%

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

Uil

Jewbali

Heeren³

et al. 2017

European J of Heart Fail

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Aims We investigated survival according to the nature of heart failure (isolated left, vs isolated right, vs biventricular heart failure) in patients undergoing extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock of different causes. Methods and results This single‐center study included 132 patients with acute myocardial infarction (20%), acute on chronic heart failure (14%), post cardiotomy (17%), cardiac allograft failure (8%), pulmonary embolism (16%), and acute nonischemic heart failure (25%). Ventricular function was a priori assessed by transthoracic echocardiography (isolated left (26%), isolated right (22%), or biventricular heart failure (52%)). The primary endpoint was all‐cause mortality at 90 days and long‐term. Predictors for adverse outcome were identified by univariate and multivariate Cox regression analysis. Median duration of ECMO support was 6 [3–9] days. Ninety‐day survival was 51% (isolated LV failure 32% vs. isolated RV failure 62% vs. biventricular failure 55%, p = 0.04). The presence of isolated left ventricular failure was a predictor for 90‐day mortality, irrespective of diagnosis and SAVE score. In patients who survived 90 days following ECMO implantation, long‐term (4‐year) survival was excellent (95%, no difference between subgroups). Conclusion Isolated left ventricular failure was an independent predictor for 90‐day outcome.

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“…Effective LV assist should reduce preload of the LV in order to promote myocardial recovery. This can be accomplished by placing a venting catheter into the LV or left atrium [ 12 ]. Some LV assist devices, such as the Impella, are designed to avoid surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

A novel catheter with retractable stent that can prevent aortic insufficiency during left ventricular assist

et al. 2018

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Left ventricle (LV) assist, which refers to the use of a mini-pump or catheter implanted across the aortic valve connected to the pump, can promote myocardial recovery after left ventricle failure. However, conventional LV assist catheters compress the aortic valve, which can induce aortic insufficiency. Here we describe a novel LV assist catheter containing a retractable stent at its distal end that may prevent such insufficiency. The device was tested in six goats in which the coronary artery was ligated to induce acute LV failure, and then an LV assist was installed with a novel catheter in the left ventricle via the left subclavian artery. Inserting the catheter into the left ventricle caused mild to moderate aortic insufficiency. Releasing the stent maintained the catheter in the center of the three valve leaflets, which resolved the aortic insufficiency and, within a few minutes, led to significantly lower left ventricle end diastolic pressure (9.0±3.0 mmHg) than without stent release (17.6±5.0 mmHg, p = 0.012) as well as significantly higher left ventricle dP/dtmax (614±299 mmHg/s) than without stent release (343±245 mmHg/s, p = 0.03). Our results indicate that this novel drainage catheter with retractable stent can effectively prevent aortic insufficiency by maintaining the catheter in the center of the aortic valve leaflets, thereby lowering left ventricular end diastolic pressure and improving systolic function.

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Experimental Venoarterial Extracorporeal Membrane Oxygenation Induces Left Ventricular Dysfunction

Cited by 37 publications

References 24 publications

Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience

Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience

Isolated left ventricular failure is a predictor of poor outcome in patients receiving veno‐arterial extracorporeal membrane oxygenation

A novel catheter with retractable stent that can prevent aortic insufficiency during left ventricular assist

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