Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit*

Aiyagari, Ranjit; Rocchini, Albert P.; Remenapp, Robert; Graziano, Joseph N.

doi:10.1097/01.ccm.0000239113.02836.f1

Cited by 178 publications

(137 citation statements)

References 12 publications

Supporting

Mentioning

131

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, the device requires relatively less resources and experience than traditional extracorporeal membrane oxygenation (ECMO) and implantable LVADs, thereby simplifying the management and troubleshooting by spoke centres. Additionally, complications associated with peripheral ECMO and implantable LVADs, such as left-heart distention, lower limb ischemia, hemolysis, bleeding and strokes, are reduced or avoided (7)(8)(9). In addition, transport with the device (particularly air transport) is more comparable with a streamlined IABP transfer than with an involved ECMO or LVAD transfer in terms of equipment, electrical requirements and personnel required.…”

Section: Discussionmentioning

confidence: 99%

Interprovincial spoke-to-hub transport using the Impella Recover LP 5.0 left ventricular assist device as a bridge to long-term circulatory support

Guirgis

Kumar

Zieroth

et al. 2010

Canadian Journal of Cardiology

View full text Add to dashboard Cite

C urrent hospital administrative practices categorize health care centres in a network of spokes and hubs (1). The 'spokes' are primary care centres that offer immediate yet temporary life-sustaining therapies, and channel the most severe cases to centres or 'hubs' that can provide the long-term treatment not available at the spoke sites. In the setting of mechanical circulatory support, long-term left ventricular assist devices (LVADs) and transplant therapies are only used at a few hub centres. The relatively lower technical requirements of the Impella Recover LP 5.0 LVAD (ABIOMED Inc, USA) translate into greater utilization by spoke centres for the treatment of cardiogenic shock (2,3). Based on a literature review, we report the first case demonstrating successful use of the Impella Recover LP 5.0 LVAD, implanted under local anesthetic, for the purpose of interprovincial spoke-to-hub transport in a bridge-to-bridge-to-transplant procedure. case presentationMr S is a 54-year-old man with a greater than 10-year history of nonischemic dilated cardiomyopathy and symptomatic congestive heart failure managed medically. Following a sudden onset of angina, he presented to his local rural hospital and was diagnosed with an anterior ST elevation myocardial infarction complicated by high-grade atrioventricular block. Following stabilization with dopamine (5 µg/kg/min to 15 µg/kg/min) and insertion of a transvenous pacing wire, the patient was transferred to a tertiary care centre with cardiac surgery onsite, approximately 2 h away. On arrival, the patient had a blood pressure of 86/69 mmHg, a heart rate of approximately 70 beats/min (paced), a respiratory rate of 18 breaths/min and a hemoglobin saturation of 95% on 5 L supplemental oxygen. He had an increased jugular venous pressure of approximately 5 cm to 6 cm, with cool and clammy extremities. The electrocardiogram demonstrated third-degree atrioventricular block with increasing frequency of nonsustained ventricular tachycardia. He underwent emergent percutaneous coronary catheterizaton and thrombectomy of his proximal left anterior descending artery, with the remaining coronary arteries essentially unremarkable. The culprit lesion was not stented due to the patient's severe acetylsalicylic acid allergy and the potential need for heart transplantation. Despite restoration of Thrombolysis in Myocardial Infarction 3 flow following the procedure, the patient required increasing circulatory support, at which time an intra-aortic balloon pump (IABP) was inserted. The documented left ventricular end-diastolic pressure at this time was 39 mmHg. In the hours following, despite the use of inotropic Current hospital administrative practices categorize health care centres in a network of 'spokes' (primary care centres) and 'hubs' (tertiary care centres). For the treatment of cardiogenic shock, long-term left ventricular assist devices (LVADs) and transplant therapies are only used at a few hub centres nationwide and are, thus, only available to patients living in close proximit...

show abstract

Section: Discussionmentioning

confidence: 99%

Interprovincial spoke-to-hub transport using the Impella Recover LP 5.0 left ventricular assist device as a bridge to long-term circulatory support

Guirgis

Kumar

Zieroth

et al. 2010

Canadian Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…In those cases, the need for intervention for left ventricular decompression must be considered. [4][5][6][7] Management of ventricular distention can be through conservative, pharmaceutic (inotropic agents, diuretics), interventional, or surgical ways. Interventional modalities for LVD include intraaortic balloon pump (to increase coronary perfusion, improve contractility, and reduce afterload), atrial septostomy, trans-septal left atrial drain, or other devices such as the Impella (Abiomed, Danvers, MA, USA).…”

Section: Discussionmentioning

confidence: 99%

Untitled

Gültekin

Ersoy²,

Akkaya³

et al. 2016

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Left ventricular distention can be recognized during the use of venoarterial extracorporeal membrane oxygenation as a key complication. Left ventricular decompression may decrease pulmonary pressure, minimize ventricular distention, and allow myocardial recovery. Materials and Methods: We applied venoarterial extracorporeal membrane oxygenation to 4 patients while on a wait list for cardiac transplant. Results: Two patients with severe heart failure developed high end-diastolic pressures leading to left ventricular distention. We used atrial venting methods to decrease the pressure. Conclusions: Here, we discussed the strategies to manage ventricular distention by conservative, interventional, and surgical means.

show abstract

“…Minimally invasive strategies such as percutaneous transseptal left atrial decompression (38) and subxiphoid surgical approaches to drain the LV (39) have been described to reduce LV distension. The residual atrial defect may require correction once the patient has been weaned from mechanical support.…”

Section: Central Va-ecmomentioning

confidence: 99%

Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

Banfı¹,

Pozzi²,

Brunner³

et al. 2016

J. Thorac. Dis.

View full text Add to dashboard Cite

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has known a widespread application over the last decade and is now an effective and valuable therapeutic option in refractory cardiogenic shock of various etiologies. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of endorgan function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term mechanical circulatory support (MCS) implantation. VA-ECMO could also be suggested as a rescue therapeutic option for refractory cardiac arrest. It showed promising results in the specific setting of in-hospital cardiac arrest and survival rates with good neurological outcome are reported between 20% and 40%. Conversely, there are contrasting data in the literature about survival after VA-ECMO for out-of-hospital cardiac arrest, as results are highly dependent on low-flow time. The aim of the present report is to offer an overview of different cannulation techniques of VA-ECMO.

show abstract

Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit*

Abstract: Adequate decompression of the left atrium can be achieved by transseptal placement of a left atrial drain incorporated into the ECMO circuit. This technique represents a reasonable alternative to blade or balloon atrial septostomy for patients requiring left atrial decompression.

Cited by 178 publications

References 12 publications

Interprovincial spoke-to-hub transport using the Impella Recover LP 5.0 left ventricular assist device as a bridge to long-term circulatory support

Interprovincial spoke-to-hub transport using the Impella Recover LP 5.0 left ventricular assist device as a bridge to long-term circulatory support

Untitled

Veno-arterial extracorporeal membrane oxygenation: an overview of different cannulation techniques

Contact Info

Product

Resources

About