Clinical efficacy of direct or indirect left ventricular unloading during venoarterial extracorporeal membrane oxygenation for primary cardiogenic shock

Char, Steven; Fried, Justin; Melehy, A.; Mehta, Sanket; Ning, Yuming; Kurlansky, Paul; Takeda, Koji

doi:10.1016/j.jtcvs.2021.06.024

Cited by 30 publications

(25 citation statements)

References 18 publications

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“…In patients who undergo VA-ECMO for cardiogenic shock, there is no significant difference in haemodynamic parameters between IABP and Impella (Abiomed) in left ventricular afterload reduction. However, the use of IABP combined with ECMO may help reduce the mortality rate and improve the 180-day survival rate ( 29 ). IABP is the most commonly used left ventricular decompression device in VA-ECMO because it can be implanted percutaneously at the bedside within a short period and is easy to operate.…”

Section: Discussionmentioning

confidence: 99%

Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Bai

Pan

et al. 2022

Front. Med.

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BackgroundThe safety and feasibility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support in high-risk percutaneous coronary intervention (HR-PCI) remain unclear.MethodsThis retrospective study included patients with complex and high-risk coronary artery disease who underwent elective PCI with VA-ECMO support pre-operatively during March 2019–December 2020. Rates of VA-ECMO-related complications, complications during PCI, death, myocardial infarction, and stroke during hospitalisation and 1-year post-operatively were analysed.ResultsOverall, 36 patients (average age: 63.6 ± 8.9 years) underwent PCI. The average duration of VA-ECMO support was 12.5 (range, 3.0–26.3) h. Intra-aortic balloon pump counterpulsation was used in 44.4% of patients. The SYNTAX score was 34.6 ± 8.4 pre-operatively and 10.8 ± 8.8 post-operatively (P < 0.001). Intraoperative complications included pericardial tamponade (N = 2, 5.6%), acute left-sided heart failure (N = 1, 2.8%), malignant arrhythmia requiring electrocardioversion (N = 2, 5.6%), and no deaths. Blood haemoglobin levels before PCI and 24 h after VA-ECMO withdrawal were 145.4 ± 20.2 g/L and 105.7 ± 21.7 g/L, respectively (P < 0.001). Outcomes during hospitalisation included death (N = 1, 2.8%), stroke (N = 1, 2.8%), lower limb ischaemia (N = 2, 5.6%), lower limb deep venous thrombosis (N = 1, 2.8%), cannulation site haematoma (N = 2, 5.6%), acute renal injury (N = 2, 5.6%), bacteraemia (N = 2, 5.6%), bleeding requiring blood transfusion (N = 5, 13.9%), and no recurrent myocardial infarctions. Within 1 year post-operatively, two patients (5.6%) were hospitalised for heart failure.ConclusionsVeno-arterial extracorporeal membrane oxygenation mechanical circulation support during HR-PCI is a safe and feasible strategy for achieving revascularisation in complex and high-risk coronary artery lesions. VA-ECMO-related complications require special attention.

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Section: Discussionmentioning

confidence: 99%

Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Bai

Pan

et al. 2022

Front. Med.

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“…VA-ECMO treatment is therefore often applied in combination with left-ventricular (LV) decompression strategies such as IABP and IMPELLA treatment in order prevent LV dilatation resulting from increased LV afterload [31,32]. In fact, large meta-analyses suggest that LV decompression strategies either with IABP, IMPELLA, or left atrial or pulmonary artery cannulation is associated with lower mortality [31,33,34]. In accordance, LV decompression was likewise associated with a lower 30 day mortality in a propensitymatched cohort study while associated with an increased risk of severe bleeding, limb ischemia, and a need for renal replacement therapy [26,35].…”

Section: Venoarterial Extracorporeal Membrane Oxygenation (Va-ecmo)mentioning

confidence: 99%

Cardiac Surgery in Advanced Heart Failure

Hullin

Meyer

Yerly

et al. 2022

JCM

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Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the number of heart transplantations. This narrative review summarizes recent progress in surgical treatment options of advanced heart failure and proposes an algorithm for treatment of the advanced heart failure patient at >65 years of age.

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“…In a more recent study, Schrage and colleagues 12 found that the effect of adding an Impella to VA-ECMO on 30-day mortality might be significantly better when inserted early (HR, 0.76; 95% CI, 0.60-0.97; P = .03) but less clearly when delayed (HR, 0.77; 95% CI, 0.51-1.16; P = .22). In a retrospective single-center study, Char and colleagues 27 found no difference in survival between patients with pre-ECMO unloading (at the time of ECMO insertion or before ECMO) versus reactive unloading (in response to clinical criteria).…”

Section: Evidence-based Approach To Left Ventricular Unloadingmentioning

confidence: 97%

“…Moreover, the reported use of mechanical LV unloading varies widely in the literature, ranging from 5% to 50%. 17 , 27 , 28 This probably reflects heterogeneity in definitions, patient populations, and management strategies between studies. Belohlavek and colleagues 28 described that although some LV overload may occur in up to 70% of patients on VA-ECMO, urgent decompression is undertaken in only approximately 10% of patients, whereas an additional 20% might need a delayed unloading intervention.…”

Section: Evidence-based Approach To Left Ventricular Unloadingmentioning

confidence: 99%

Controversies in extracorporeal membrane oxygenation: Immediate versus watchful waiting for venoarterial extracorporeal membrane oxygenation venting

Cavayas¹,

Noly²,

Singh³

et al. 2021

JTCVS Open

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Clinical efficacy of direct or indirect left ventricular unloading during venoarterial extracorporeal membrane oxygenation for primary cardiogenic shock

Cited by 30 publications

References 18 publications

Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Veno-Arterial Extracorporeal Membrane Oxygenation in Elective High-Risk Percutaneous Coronary Interventions

Cardiac Surgery in Advanced Heart Failure

Controversies in extracorporeal membrane oxygenation: Immediate versus watchful waiting for venoarterial extracorporeal membrane oxygenation venting

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