Extracorporeal Life Support in Myocardial Infarction-Induced Cardiogenic Shock: Weaning Success

Wagner, Julian; Tiller, Christina; Dietl, Marion; Ulmer, Hanno; Brenner, Christoph; Stastny, Lukas; Sommerauer, Florian; Mair, Peter; Ruttmann, Elfriede; Program, Innsbruck Liver-in-Heart-Failure

doi:10.1016/j.athoracsur.2019.04.049

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…Hospital survival was 40% and 1-year survival was 75%. Our hospital survival results were not superior to those reported by Wagner and associates, who reported hospital survival of 68.2% and 1-year survival of 59.1% [Wagner 2019].…”

Section: Discussioncontrasting

confidence: 84%

Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study

Abdeljawad

Mubarak

2022

HSF

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Background: Extracorporeal membrane oxygenator (ECMO) has been implemented in refractory postcardiotomy cardiogenic shock (PCCS) patients to maintain excellent oxygenation and hemodynamic support. The aim of this study is to compare the results of early ECMO implantation to treat refractory PCCS in emergency versus elective patients who developed univentricular or biventricular pump failure. Patients and methods: Between January 2019 and June 2021, 35 patients received ECMO after refractory PCCS. Patients have been categorized into two groups: Group A contains 18 patients who were urgently operated on and Group B, which includes 17 patients who were electively operated on. ECMO was implanted through central cannulation (right atrium and ascending aorta), or through peripheral cannulation (femoral vessels or through axillary artery). Results: There was no statistically significant difference between the two ECMO groups in the preoperative patient’s characteristics, complication rate, duration of mechanical ventilation, post-ECMO weaning hospital stay, duration of ICU stay, in-hospital mortality, and number of patients discharged from the hospital or in 1-year survival on follow up. Conclusion: Early use of ECMO in high-risk emergency cardiac surgery should be taken into consideration when possible, without hesitance. Emergency and elective patients benefit equally from ECMO implantation and show comparable complication rates.

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Section: Discussioncontrasting

confidence: 84%

Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study

Abdeljawad

Mubarak

2022

HSF

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“…Four studies commented on the timing of VA-ECMO initiation in relation to coronary revascularization. 21,23,25,27 Veno-arterial ECMO initiation occurred either during or after PCI and in-hospital mortality ranged from 33-67.3%. Pozzi et al 24 specifically looked at the impact of timing of VA-ECMO initiation on survival in patients with refractory cardiogenic shock following acute MI and found no survival benefit in the early implantation (on the day of PPCI) of VA-ECMO (hazard ratio 1.18; 95% CI 0.94-1.48).…”

Section: Resultsmentioning

confidence: 99%

The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis

Paddock,

Meng,

Johnson

et al. 2024

European Journal of Preventive Cardiology

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Aim To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock. Methods Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. Results The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality. Conclusions VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.

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“…Any cause of myocardial ischemia or circulatory dysfunction should be sought and remedied. 4,16 Suitable end organ function and recovery is critical. 2,7,12 Metabolic markers can be used as indicators of systemic organ function and perfusion.…”

Section: Respiratory Criteriamentioning

confidence: 99%

How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

Trahanas

Crowley

et al. 2021

ASAIO Journal

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Adequate and durable recovery in patients supported with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be challenging to predict. Extracorporeal membrane oxygenation weaning is the process by which the ECMO flows are decreased to assess if a patient is ready for decannulation. The optimal strategies for deciding who to wean and how to wean VA ECMO remain undefined. A retrospective literature review was performed to understand the evidence supporting current practices in ECMO weaning and in particular patient selection and methods. Most published work and expert opinions agree that once the underlying process has resolved, the minimum required physiologic parameters for weaning from ECMO include: hemodynamic stability and cardiac pulsatility, adequate lung function to support oxygenation and ventilation, and evidence of recovered end organ function. Echocardiography is universally used to assess cardiac function during the weaning process. Currently, there is no consensus regarding who is eligible to wean or how to wean ECMO in adults. We have reviewed the literature to summarize the evidence and expert opinions behind VA ECMO weaning, and give an example of the protocol used at our center. We believe this protocol optimizes patient selection for weaning and helps to predict successful decannulation.

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Extracorporeal Life Support in Myocardial Infarction-Induced Cardiogenic Shock: Weaning Success

Cited by 7 publications

References 29 publications

Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study

Does an Early Implantation of Extracorporeal Membrane Oxygenator in High-Risk Emergency Open Heart Surgery Patients Improve the Outcome in Comparison with Elective Patients? A Prospective Cohort Comparative Study

The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis

How to Turn It Down: The Evidence and Opinions Behind Adult Venoarterial Extracorporeal Membrane Oxygenation Weaning

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