Impella left ventricular assist device in cardiac arrest after spinal anaesthesia for caesarean section

Desai, Nayan; Chaudhry, Kunal; Aji, Janah

doi:10.1136/bcr-2015-211958

Cited by 7 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Apart from ECMO, the use of other percutaneous mechanical circulatory assist devices such as intra-aortic balloon pump (IABP) and Impella has also been described for the management of cardiogenic shock in obstetric patients [18, 19]. Currently, there is insufficient data comparing these modalities for the management of peripartum cardiomyopathy and clinicians should select an appropriate device taking into account the required cardiovascular support (RV versus LV versus both), the oxygenation of the patient, periprocedural risks, and the local expertise available [20].…”

Section: Discussionmentioning

confidence: 99%

Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular Systolic Dysfunction Undergoing Cesarean Delivery

Bui

Mascaro

Henao-Mejia

et al. 2019

Case Reports in Anesthesiology

View full text Add to dashboard Cite

Obstetric patients with heart failure undergoing cesarean delivery are high risk and the perioperative care of these patients poses significant multidisciplinary challenges. In contrast to the nonobstetric patient population the potential role of mechanical circulatory support in parturients with heart failure is not well established and the use of extracorporeal membrane oxygenation (ECMO) has rarely been reported. We report the case of a super morbidly obese patient with decompensated heart failure, pulmonary hypertension, and superimposed preeclampsia undergoing preemptive ECMO cannulation for urgent cesarean delivery.

show abstract

Section: Discussionmentioning

confidence: 99%

Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular Systolic Dysfunction Undergoing Cesarean Delivery

Bui

Mascaro

Henao-Mejia

et al. 2019

Case Reports in Anesthesiology

View full text Add to dashboard Cite

show abstract

“…Previous use has been described in the postpartum setting 12 h following cesarean delivery in an acutely decompensating patient. 5 The device implanted in this case is approved for temporary left ventricular support (≤4–6 days) for patients in cardiogenic shock not responsive to optimal medical management and conventional treatment measures as well as for prophylactic use during high-risk percutaneous coronary interventions. It functions to augment cardiac output up to 2.5–5 l/min independent of the patient’s cardiac pump strength by delivering blood from the left ventricle to the ascending aorta.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic percutaneous left ventricular assist device in pregnancy

et al. 2018

View full text Add to dashboard Cite

Pregnancy-associated cardiomyopathy can present earlier in gestation than traditionally defined peripartum cardiomyopathy. Management and optimal delivery timing for these patients are not well defined. We present the case of a 30-year-old primigravid at 26 weeks who presented with new onset ventricular tachycardia, biventricular cardiac failure, and severe mitral regurgitation. She was medically stabilized for two weeks prior to delivery with modest improvement in her condition. Due to concern for life-threatening cardiac failure and pulmonary edema at the time of delivery, a percutaneous left ventricular assist device was inserted immediately prior to cesarean delivery. She remained on mechanical circulatory support for 36 h. We discuss considerations regarding use of a percutaneous left ventricular assist device as a novel therapy to support the hemodynamic changes following delivery in parturients with decompensated heart failure.

show abstract

“…Bradycardia due to an increase in vasopressin levels without changes in catecholamine levels is observed after the head-up tilt in the presence of sympathetic blockade [26]. Pregnant patients undergoing spinal Cardiac Arrest Following Central Neuraxial Block DOI: http://dx.doi.org/10.5772/intechopen.106600 anesthesia are at increased risk for hypotension and bradycardia due to aortocaval compression and a higher level of spinal block [27].…”

Section: Intrinsic Cardiac Reflexesmentioning

confidence: 99%

“…After the restoration of circulation, myocardial stunning may need vasopressor support for prolonged period. Refractory cardiac failure may need to leave ventricular assist device [27].…”

Section: Treatment Of Bradycardia and Hypotensionmentioning

confidence: 99%

“…Evolution in the knowledge of the pathophysiology of CNB, better availability of monitoring devices, safer local anesthetic agents and early treatment, and now the outcome have improved a lot in the last two decades [5,6,8]. After restoration of circulation, myocardial stunning may need vasopressor support or left ventricular assist device for refractory cardiac failure [27]. Patient with CA within 20 minutes after spinal has a better prognosis than delayed CA (more than 40 minutes), in which resuscitation is difficult due to blood loss during surgery, postural changes, and surgical procedures like cementing [16].…”

Section: When To Anticipate Cardiac Arrest?mentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Arrest Following Central Neuraxial Block

Kulkarni¹,

Futane²

2023

Updates in Anesthesia - The Operating Room and Beyond

View full text Add to dashboard Cite

Central neuraxial blocks (CNB) are used worldwide in anesthesia practice. They are safe, however, not devoid of untoward complications. Cardiac arrest (CA) is one of the major devastating complications. The anesthesiologists are concerned about CA as it can occur unexpectedly and suddenly even in a young ASA grade I patient, undergoing elective surgery, at any time during and after administration of CNB in spite of continuous vigilance. A better understanding of the physiology of CNB, availability of monitoring devices, and safer local anesthetic drugs contribute to reduced mortality, yet cases of CA are reported even recently. These case reports provide information relevant to particular incidents and may be inadequate to provide comprehensive information to explain the overall clinically important aspects related to CA following CNB. This chapter would provide a summary and analysis of the current recommendations about etiology, predisposing factors, preventive measures, and various measures tried for the treatment of cardiac arrest, although the exact etiology and predisposing factors are still not known. The comprehensive information would be helpful for anesthesiologists during day-to-day practice and to increase the safety of patients undergoing CNB. Proper patient selection, pre-/co-loading of fluids, the modifying technique of CNB as per patient’s need, early use of epinephrine during bradycardia refractory to atropine, continuous monitoring, vigilance during intra- and postoperative period would help in prevention, early detection, and prompt treatment of CA. Challenges faced by anesthesiologists during CNB practice and newer modalities used for the treatment of refractory CA are also discussed. The mystery of sudden unexpected CA is yet to be solved and research in this direction is warranted. Electronic medical record keeping and reporting untoward incidence to the national board will also help to improve patient safety in the future.

show abstract

Impella left ventricular assist device in cardiac arrest after spinal anaesthesia for caesarean section

Cited by 7 publications

References 3 publications

Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular Systolic Dysfunction Undergoing Cesarean Delivery

Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular Systolic Dysfunction Undergoing Cesarean Delivery

Prophylactic percutaneous left ventricular assist device in pregnancy

Cardiac Arrest Following Central Neuraxial Block

Contact Info

Product

Resources

About