Analysis of the 2020 EACTS/ELSO/STS/AATS Expert Guidelines on the Management of Adult Postcardiotomy Extracorporeal Life Support

Welker, Carson C.; Huang, Jeffrey; Ramakrishna, Harish

doi:10.1053/j.jvca.2021.06.022

Cited by 6 publications

(4 citation statements)

References 159 publications

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“…There is a subset of patients who globally qualify for transplant, but may not qualify for durable LVAD at the time of evaluation due to cardiac arrest with unclear neurological status or cardiogenic shock with hemodynamic instability 50. In these patients, temporary support may be a better option (deemed a “bridge-to-decision”) to reevaluate candidacy for transplant or more permanent MCS options 49. The last group, those receiving MCS for DT, have been deemed ineligible for cardiac transplant but may benefit from additional support to improve quality of life.…”

Section: Modern Patient Selectionmentioning

confidence: 99%

“…48 VV-ECMO cannot be used to provide RV support because blood is drained from either vena cava and returned to the RA, and RV support necessitates outflow into the PA. 38 Some indications for VA-ECMO include BTT or more durable MCS such as an LVAD, worsening cardiogenic shock despite maximum inotropic support, failed CPB wean, primary graft dysfunction in postheart transplant patients, congenital heart disease, myocarditis, and postcardiac arrest. 49 The TAH, namely the SynCardia TAH, consists of 2 ventricles made of polyurethane, each containing two mechanical single leaflet tilting disk valves that provide pneumatically driven, pulsatile blood flow. 19,26 It is currently the only FDA-approved TAH in the United States, and is approved solely for use as BTT and not for DT.…”

Section: Modern Optionsmentioning

confidence: 99%

“…50 In these patients, temporary support may be a better option (deemed a "bridge-to-decision") to reevaluate candidacy for transplant or more permanent MCS options. 49 The last group, those receiving MCS for DT, have been deemed ineligible for cardiac transplant but may benefit from additional support to improve quality of life. In this case, the permanent devices are the only option.…”

Section: Modern Patient Selectionmentioning

confidence: 99%

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Mechanical circulatory support devices: historical overview and modern approach

Daubenspeck¹

2022

International Anesthesiology Clinics

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Heart failure (HF) continues to be a pervasive problem both nationally and globally, and with an aging population its prevalence is only increasing. It is estimated that ~6 million Americans over 20 years old were diagnosed with HF between 2015 and 2018, and projections estimate that the number will be > 8 million by 2030. 1 There have been multiple classification systems developed to help risk stratify, prognosticate, and determine treatment for HF patients. These include the New York Heart Association (NYHA) functional classification, the American College of Cardiology (ACC) and American Heart Association (AHA) stages, and The Interagency Registry for Mechanically Assisted Circulation (INTERMACS) profiles. 2,3 The ultimate goal of these systems is to provide early identification and create a pathway for intervention whether in the form of medical therapy, mechanical circulatory support (MCS), or a combination of both. The term MCS encompasses a wide variety of options ranging from percutaneous temporary devices used as a bridge-to-transplantation (BTT) or myocardial recovery to permanent implantable devices meant as destination therapy (DT). The MCS devices commonly used today include the intraaortic balloon pump (IABP), Impella (Abiomed, Danvers, MA), TandemHeart (LivaNova, London, UK), total artificial heart (TAH), venoarterial and veno-venous extracorporeal membrane oxygenation (VA-ECMO and VV-ECMO), durable left ventricular assist devices (LVAD), and percutaneous right ventricular assist devices (RVAD). Various models and configurations of these listed devices can be used to support the left or right ventricle individually (LV, RV), and some can be used to provide biventricular support. The who, what, and when of MCS requires a multidisciplinary team approach, considering numerous variables in order to provide the optimal therapy for each individual patient. This article presents an overview of the history and indications for MCS, as well as how to select patients for MCS and a brief explanation of available devices.

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Section: Modern Patient Selectionmentioning

confidence: 99%

Section: Modern Optionsmentioning

confidence: 99%

Section: Modern Patient Selectionmentioning

confidence: 99%

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Mechanical circulatory support devices: historical overview and modern approach

Daubenspeck¹

2022

International Anesthesiology Clinics

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“…The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) has improved refractory cardiogenic shock mortality [ 1 , 2 ]. VA ECMO is used for bridge-to-recovery, bridge-to-transplantation, or bridge-to-decision purposes [ 3 , 4 ]. Several recommendations have been published relative to the indications, management and weaning of VA ECMO [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of Arterial Pressure of Oxygen and Carbon Dioxide in Patients Supported by Veno-Arterial ECMO

Andrei

Nguyen

Berthoud

et al. 2022

JCM

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Background: The present study aimed to assess the determinants of arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) in the early phase of veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Even though the guidelines considered both the risks of hypoxemia and hyperoxemia during ECMO support, there are a lack of data concerning the patients supported by VA ECMO. Methods: This is a retrospective, monocentric, observational cohort study in a university-affiliated cardiac intensive care unit. Hemodynamic parameters, ECMO parameters, ventilator settings, and blood gas analyses were collected at several time points during the first 48 h of VA ECMO support. For each timepoint, the blood samples were drawn simultaneously from the right radial artery catheter, VA ECMO venous line (before the oxygenator), and from VA ECMO arterial line (after the oxygenator). Univariate followed by multivariate mixed-model analyses were performed for longitudinal data analyses. Results: Forty-five patients with femoro-femoral peripheral VA ECMO were included. In multivariate analysis, the patients’ PaO2 was independently associated with QEC, FDO2, and time of measurement. The patients’ PaCO2 was associated with the sweep rate flow and the PpreCO2. Conclusions: During acute VA ECMO support, the main determinants of patient oxygenation are determined by VA ECMO parameters.

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