Extracorporeal life support during cardiac arrest and cardiogenic shock—how good is the evidence really?

Prondzinsky, Roland; Werdan, Karl

doi:10.21037/atm.2017.01.30

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…The use of active pMCS and VA-ECMO, and the advantages that they can create, should be respected. However, there are no high-quality RCTs supporting the general use of active pMCS in patients with refractory CSMI [48,49]. As a result, ESC guidelines do not suggest the routine use of IABP in CS [33,37,50,51].…”

Section: Percutaneous Assist Devicesmentioning

confidence: 99%

“…The application number was 500 in Germany in 2012 increasing to 3000 in 2014 [57]. This worrisome increase in the use of VA-ECMO in CSMI patients is a very serious issue that needs to be assessed in more detail since it does not rely on concrete evidence but rather on conventional wisdom based on pathophysiology and the positive results published in observational studies [49,71]. An increase of 3-6 L/min in the flow, which is provided by VA-ECMO and which is necessary, cannot ensure the survival of CSMI patients.…”

Section: Va-ecmomentioning

confidence: 99%

“…When addressed as a whole, the meta-analysis data of VA-ECMOs/ECLS and pMCS are inconsistent: on the one hand, pMCSs are not better than IABP, whereas, on the other, VA-ECMOs/ECLS are better than IABP while they are not better than pMCSs. Of course, there is a need for higherquality RCTs to be able to answer the questions about the routine use of VA-ECMO/ECLS in treatment-resistant CS patients [44,49]. It is seen that 75% of the survivors after ECLS are able to go about their daily life, 25% of them return to work or school, and 57% of them are not limited in their usual activities.…”

Section: Va-ecmomentioning

confidence: 99%

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Cardiogenic Shock

Türker¹

2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) is an end-organ hypoperfusion associated with heart failure. Any reason impairing acute left ventricular (LV) or right ventricular (RV) function may cause CS. The only way to avoid CS is to provide early reperfusion in myocardial infarction (MI) patients. CS is characterized by permanent or transient rearrangement of the entire circulatory system. According to the current IABP-SHOCK II trial, 74% of the patients with CSMI are treated with norepinephrine, 53% of them with dobutamine, 26% of them with epinephrine, 4% of them with levosimendan, and 4% of them with dopamine. Percutaneous circulatory support devices such as intra-aortic balloon pump (IABP), LV assist device (LVAD), or extracorporeal life support (ECLS) create treatment options for selected patients such as CS, cardiopulmonary resuscitation, or high-risk pPCI and CABG. Extracorporeal Life Support Organization (ELSO, 2017) evaluated that the use of ECLS/VA-ECMO should be considered when the mortality risk exceeds 50% despite optimal conventional treatment in case of acute severe heart or pulmonary failure, whereas it should be assessed as a primary indication when it exceeds 80%. Early and effective revascularization is the best treatment option for CS. Thus, the organizations on the national and global basis will play the most effective role for the short-and long-term survival of patients.to survive [2]. CS occurs in approximately 5-8% of inpatients with ST-elevation myocardial infarctions (STEMI) and has a mortality rate of more than 30% [1]. CS is caused by end-organ hypoperfusion due to impaired cardiac pump function. Although CS-related mortality has declined significantly over the past decade, it continues to remain high, especially in cases of its coexistence with ischemic heart disease. Acute coronary syndrome (ACS) is still the most common cause of CS despite significant advances that have been made in its diagnosis and treatment. The most successful form of treatment is primary percutaneous coronary intervention (pPCI), which is carried out as rapidly as possible [3]. The recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems also play a role in the pathogenesis and persistence of CS.In cases where CS complicates MI (CSMI), only one in two patients survives after 1 year [4,5]. In a large study including 5782 patients, CSMI had developed in 2.5% of the patients with STEMI before admission to hospital, in 4.3% of them on the first day of hospitalization, and in 2.3% of them afterward [6]. For non-STEMI (NSTEMI) patients, these ratios were 1.2% for each condition [6]. Mortality rates were 45.7% before the hospitalization, 32.8% in the early period, and 54.1% in the late period [7]. Of 1422 CSMI patients, in the SHOCK Trial Registry, a shock is developed following left ventricular failure in 78.5% of them, acute mitral insufficiency in 6.9% of them, acute ventricular septal defect in 3.9% of them, right ventricular failure in 2.8% of them, cardiac tamponade in 1.4% of them, and ...

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Section: Percutaneous Assist Devicesmentioning

confidence: 99%

Section: Va-ecmomentioning

confidence: 99%

Section: Va-ecmomentioning

confidence: 99%

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Cardiogenic Shock

Türker¹

2019

Advances in Extra-Corporeal Perfusion Therapies

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“…In Germany, about 5,000 IABPs and 3,000 VA-ECMO systems have been implemented in 2014 (6). The bad news is that for none of these percutaneous devices a survival benefit has yet been documented in adequately sized randomized clinical trials (RCTs) (4,7). Such a RCT only exists for the use of IABP in patients with cardiogenic shock complicating myocardial infarction, with neutral effects on mortality and morbidity (8,9).…”

mentioning

confidence: 99%