Emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported percutaneous interventions in refractory cardiac arrest and profound cardiogenic shock

Radšel, Peter; Goslar, Tomaž; Bunc, Matjaž; Kšela, Juš; Gorjup, Vojka; Noč, Marko

doi:10.1016/j.resuscitation.2020.11.028

Cited by 19 publications

(19 citation statements)

References 27 publications

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“…According to their findings, patients undergoing a PVAD-supported PCI exhibited significantly lower in-hospital mortality rates than patients treated with an IABP ( 23 ). ECMO can be used for powerful haemodynamic mechanical circulation support during elective HR-PCI ( 10 , 11 ). When VA-ECMO is used in HR-PCI, not only the cardiac functional status of the patient, but also the severity of coronary artery disease should be fully considered by the interventional physician.…”

Section: Discussionmentioning

confidence: 99%

“…With increases in blood flow, VA-ECMO tends to increase the left ventricular afterload. The most common devices used for left ventricular unloading during VA-ECMO are Impella (Abiomed) and IABPs, while other strategies include atrial septostomy, surgical left ventricular apical drainage, positive inotropic drugs, diuretics, or continuous renal replacement therapy ( 10 , 11 ). Compared with no unloading, any unloading strategy can reduce the mortality of patients with VA-ECMO ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…Mechanical circulation support devices used during HR-PCI include intra-aortic balloon pump (IABP) counterpulsation, extracorporeal membrane oxygenation (ECMO), Impella (Abiomed, Danvers, MA, United States), and TandemHeart (LivaNova Medical Technology Co., Ltd., Pittsburgh, PA, United States) devices ( 4 , 10 ). Since haemodynamic instability or cardiac arrest can occur during HR-PCI, ECMO can provide strong circulatory support and significantly improve patient prognosis ( 11 ). However, veno-arterial (VA)-ECMO can increase the risk of complications, such as cardiac afterload, lower limb arterial ischaemia, blood cell destruction, and increased risk of infection ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bai

Pan

et al. 2022

Front. Med.

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“…The same argument should not be ignored for coronary revascularization in IHCA patients suffering from ACS and, therefore, saving time through e-CPR to intervene in coronary arteries percutaneously is also important on myocardial salvage and survival rate. [ 27 ] As done in emergency in ACS-related IHCA, e-CPR opens new areas in various elective or non-elective percutaneous interventions with favorable effectiveness and life-saving potential (i.e., most severe coronary interventions, transcatheter aortic valve implantation, and invasive electrophysiological procedures) under life-threatening situations, such as refractory cardiac arrest or advanced cardiogenic shock, particularly in the absence of more advanced temporary left ventricular assist devices, such as Impella® and TandemHeart®. [ 28 - 30 ]…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Gürcü¹,

Külahçıoğlu²,

Baysal³

et al. 2021

Turk Gogus Kalp Dama

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Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients. Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded. Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%. Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion.

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“…In this volume, Xu et al reported a case of a 14-year-old adolescent male patient with an anomalous left coronary artery originating from the right coronary sinus rescued by VA-ECMO and Intra-Aortic Balloon Pump followed. In addition, ECMO are often used as a supportive technique to perform surgeries in all kinds of emergent conditions ( 7 ). Zhang et al reported a case of a human immunodeficiency virus patient with severe lower tracheal obstruction underwent rigid bronchoscopy, airway tumor resection and Y-type silicone stent with ECMO supported.…”

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confidence: 99%

Editorial: Advances in extracorporeal life support in critically ill patients, volume II

Chen

Huang

et al. 2023

Front. Med.

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Editorial on the Research Topic Advances in extracorporeal life support in critically ill patients, volume II Initially used as a salvage strategy for patients with refractory cardiac and/or respiratory failure, Extracorporeal Membrane Oxygenation (ECMO) has grown in popularity since its successful application outside the operating room in the 1970's, and this trend is particularly evident in the current years (1-4). In addition, the number of centers able to provide ECMO support has expanded drastically with evolving technology and simplifying procedures (3). Therefore, the Research Topic of indications, procedures, management, and even transport of ECMO patients will never be out of date.In this Research Topic, we were able to collect volume II of advances in extracorporeal life support in critically ill patients (https://www.frontiersin.org/research-topics/33279/advancesin-extracorporeal-life-support-in-critically-ill-patients-volume-ii). The topic comprises 17 papers in this Research Topic, of which 12 are original researches and five are case reports, encompassing indications, procedure, management and complications of extracorporeal life support.As a salvage therapy, ECMO can be life-saving in numerous clinical scenarios (5,6). In this volume, Xu et al. reported a case of a 14-year-old adolescent male patient with an anomalous left coronary artery originating from the right coronary sinus rescued by VA-ECMO and Intra-Aortic Balloon Pump followed. In addition, ECMO are often used as a supportive technique to perform surgeries in all kinds of emergent conditions (7). Zhang et al. reported a case of a human immunodeficiency virus patient with severe lower tracheal obstruction underwent rigid bronchoscopy, airway tumor resection and Y-type silicone stent with ECMO supported. While Tian et al. (b) reported a case of ECMO allowing AngioJet thrombectomy in a patient with severe multiple trauma and acute massive pulmonary embolism. Nowadays, VA-ECMO is being increasingly performed by the percutaneous technique, usually under ultrasound guidance (8,9). Correspondingly, percutaneous decannulation of VA-ECMO in these patients is thereby receiving growing concerns (9)(10)(11). In this volume, Tian et al. (a) reported a case of successfully decannulation of VA-ECMO with Perclose ProGlide device application and achieved total percutaneous post-closure of femoral arteriotomies. Except for ECMO, this volume also collected a case of hemophagocytic lymphohistiocytosis secondary to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation, which was presented with multiorgan Frontiers in Medicine frontiersin.org

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Emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported percutaneous interventions in refractory cardiac arrest and profound cardiogenic shock

Cited by 19 publications

References 27 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

Extracorporeal cardiopulmonary resuscitation in-hospital cardiac arrest due to acute coronary syndrome

Editorial: Advances in extracorporeal life support in critically ill patients, volume II

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