Improving Outcomes in INTERMACS Category 1 Patients with Pre-LVAD, Awake Venous-Arterial Extracorporeal Membrane Oxygenation Support

Mori, Makoto; McCloskey, Gerard; Geirsson, Arnar; Mangi, Abeel A.; Yun, James; Jacoby, Daniel; Ahmad, Tariq; Bellumkonda, Lavanya; Lee, Forrester; Chen, Michael E.; Bonde, Pramod

doi:10.1097/mat.0000000000000908

Cited by 21 publications

(27 citation statements)

References 17 publications

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“…For instance, minimally invasive procedures have shown promising results, with less complications at least on the short term 22 . Besides, there have been reports that extracorporeal membrane oxygenation (ECMO) would allow to bridge to next therapy and lead to improved outcomes in INTERMACS 1, almost as if disease severity would be downgraded on the INTERMACS scale 23 . Another study suggested that the Impella 5.0 device can be used to facilitate the transition from ECMO to LVAD, reducing ECMO‐related complications, and allowing patient mobilization and optimization of right ventricular function before the LVAD is implanted 24 …”

Section: Discussionmentioning

confidence: 99%

Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

et al. 2021

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The use of left ventricular assist devices (LVADs) for advanced heart failure is becoming increasingly common. However, optimal timing and patient selection remain controversial. The aim of this study was to investigate outcomes of LVAD implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2). Between August 2010 and January 2020, 207 consecutive patients underwent LVAD implantation. Overall survival, major adverse events, and laboratory parameters were compared between patients in INTERMACS 1‐2 (n = 107) and INTERMACS 3‐5 (n = 100). Preoperative white blood cells, C‐reactive protein, procalcitonin, bilirubin, alanine transaminase, and lactate dehydrogenase were all significantly higher in INTERMACS 1‐2 when compared to INTERMACS 3‐5 (P < .05). During hospitalization following LVAD implantation, patients in INTERMACS 1‐2 were more likely to develop major infections (41.1% vs. 23.0%, P = .005), respiratory failure (57.9% vs. 25.0%, P < .001), mild (20.6% vs. 8.0%, P = .010), and moderate (31.8% vs. 7.0%, P < .001) right heart failure, and acute renal dysfunction (56.1% vs. 6.0%, P < .001). During a median follow‐up of 2.00 years (interquartile range (IQR) 0.24‐3.39 years), they had a higher incidence of thoracic (15.9% vs. 4.0%, P = .005) and gastrointestinal bleeding (21.5% vs. 11.0%, P = .042), as well as right heart failure (18.7% vs. 1%, P < .001). Risk of death was significantly higher in the INTERMACS 1‐2 group (hazards ratio (HR) 1.64, 95% CI 1.12‐2.40, P = .011). LVAD implantation in critically ill patients is associated with increased morbidity and mortality. Our results suggest that decision for LVAD should be not be delayed until INTERMACS 1 and 2 levels whenever possible.

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Section: Discussionmentioning

confidence: 99%

Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

et al. 2021

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“…Several reports have also demonstrated good results associated with nonintubated VA ECMO use in patients with ACS [8,9]. Mori et al [10] reported good results after adopting nonintubated VA ECMO as a bridge to ventricular-assisted device implementation.…”

Section: Kjtcvsmentioning

confidence: 99%

“…Notably, most of these studies were conducted in patients with respiratory failure from acute respiratory distress syndrome or patients waiting for lung transplantation [4][5][6]. Separately, although few cases were included, some studies have also explored awake venoarterial (VA) ECMO in patients in cardiogenic shock [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Implementation of Venoarterial Extracorporeal Membrane Oxygenation in Nonintubated Patients

Kim

Cho

et al. 2021

J Chest Surg

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Background Although extracorporeal membrane oxygenation (ECMO) is generally performed percutaneously, the technology is deployed under sedation and necessitates endotracheal intubation. However, in some patients, the use of venoarterial (VA) ECMO without intubation may be beneficial. Herein, we describe our experiences with VA ECMO performed without prior endotracheal intubation. Methods A total of 783 patients treated with VA ECMO at a single center between January 2013 and July 2018 were reviewed retrospectively. We included patients who underwent successful VA ECMO implementation without prior endotracheal intubation, and excluded those who were younger than 18 years, had ongoing cardiopulmonary resuscitation status, and had poor quality of the vessels needed for percutaneous cannulation. The primary study outcome was in-hospital survival. Results In total, 50 patients were included in this study, 94% of whom showed cardiogenic shock. The mean age of the study participants was 56.3±14.5 years. The median VA ECMO support time was 7 days (range, 2–13 days). Twenty-one patients (42%) did not receive ventilator care during the VA ECMO support period, while 29 patients (58%) progressed to intubation after VA ECMO implementation. The rates of survival at discharge and weaning success were 82% (n=41) and 92% (n=46), respectively, and 80% (n=40) of patients presented good Glasgow–Pittsburgh Cerebral Performance Categories scores at discharge. Conclusion Even in patients with cardiogenic shock, percutaneous VA ECMO can be introduced safely without prior endotracheal intubation by an experienced care team. The application of nonintubated VA ECMO might be a feasible strategy in selected cases.

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“…Awake VA ECMO in patients presenting with acute on chronic heart failure works as a means for assessing patients suitable for ventricular assist devices (VADs) while temporarily supporting biventricular functions. Awake ECMO may thus help to stabilize end-organ functions, downgrade the disease for better outcomes, or work as a bridge to heart transplant [12,13].…”

Section: Patient Selectionmentioning

confidence: 99%

Awake ECMO and mobilizing patients on ECMO

Haji¹,

Mehra²,

Doraiswamy³

2021

Indian J Thorac Cardiovasc Surg

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Extracorporeal membrane oxygenation (ECMO) is a lifesaving technology in critically ill patients who present with cardiac/ pulmonary/combined cardiopulmonary failure. These patients are the sickest of all patients in any critical care unit and will invariably have a prolonged course and rehabilitation. Spontaneous breathing and early mobilization can reduce the intensive care unit (ICU)-acquired weakness, improve functional recovery, and reduce superadded infections and length of stay in the hospital, thus decreasing the cost of treatment. In low socioeconomic countries, there is an associated challenge of the availability of specially trained personnel necessary to manage patients on ECMO. Managing and ambulating an awake patient on ECMO is very labour-intensive and poses various challenges. Every ECMO program should aim to develop goals, methods, and protocols to this end. These can be derived from best practices worldwide by suitably adapting to available personnel and equipment. In this review, we aim to highlight the advantages and associated challenges of awake ECMO and describe protocols to aid safe ambulation and physiotherapy for ECMO patients.

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Improving Outcomes in INTERMACS Category 1 Patients with Pre-LVAD, Awake Venous-Arterial Extracorporeal Membrane Oxygenation Support

Cited by 21 publications

References 17 publications

Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

Outcomes of left ventricular assist device implantation for advanced heart failure in critically ill patients (INTERMACS 1 and 2): A retrospective study

Implementation of Venoarterial Extracorporeal Membrane Oxygenation in Nonintubated Patients

Awake ECMO and mobilizing patients on ECMO

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