Left Ventricular Unloading During Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Russo, Juan; Aleksova, Natasha; Pitcher, Ian; Couture, Étienne; Parlow, Simon; Faraz, Mohammad Ali; Visintini, Sarah; Simard, Trevor; Santo, Pietro Di; Mathew, Rebecca; So, Derek; Takeda, Koji; Garan, A.R.; Karmpaliotis, Dimitrios; Takayama, Hiroo; Kirtane, Ajay J.; Hibbert, Benjamin

doi:10.1016/j.jacc.2018.10.085

Cited by 286 publications

(221 citation statements)

References 32 publications

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“…IABP has been the most used technique to unload the left ventricle during ECMO support [37]. The IABP acts with several "indirect" mechanisms reducing both the LV afterload (enhanced systolic ejection) and the LV end-diastolic pressure (enhanced left atrial and pulmonary venous unloading).…”

Section: Iabpmentioning

confidence: 99%

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Kowalewski

Malvindi

Zieliński³

et al. 2020

JCM

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During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82-0.93; p < 0.0001; I 2 = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21-1.51; p < 0.00001; I 2 = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68-0.83; p < 0.0001; I 2 = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with Abstract Structured summary 2Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.

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Section: Iabpmentioning

confidence: 99%

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Kowalewski

Malvindi

Zieliński³

et al. 2020

JCM

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“…Surgical or catheter‐based insertion of a reperfusion catheter is often necessary to prevent limb ischemia. In addition, concomitant LV unloading is often required during VA‐ECMO support due to an increase in LV afterload leading to LV distension and increased LV filling pressure . In contrast to VA‐ECMO, a relatively low incidence of manageable adverse events was observed with the use of the Impella device in the 15 patients reported in this study.…”

Section: Discussionmentioning

confidence: 78%

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Elkayam

Schäfer

Chieffo

et al. 2019

Clinical Cardiology

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Background Percutaneous mechanical circulatory support (MCS), such as the Impella heart pump is a valuable option for cardiogenic shock (CS), although the use of Impella in CS due to peripartum cardiomyopathy (PPCM) is limited. Objective To assess outcomes in women with PPCM supported with an Impella device from the global catheter‐based ventricular assist device (cVAD) Registry. Methods and Results A total of 15 women with PPCM supported with Impella devices between November 2008 and October 2015 were included. Of the 15 women, five were treated at Hannover medical school and have been reported previously, the rest were managed at various US hospitals. The mean age was 30.0 ± 7.34 years, eight women were Caucasian, and seven were African‐American. The occurrence of PPCM was post‐delivery in eight (53.3%), at delivery in one (6.7%), and during gestation in four women (26.7%). At admission, all women had severe heart failure with a mean ejection fraction of 14.7 ± 6% and 13 women (86.7%) presented with CS. Prior to Impella, 100% were mechanically ventilated, 79% received inotropes/vasopressors, 20% supported with IABP, and 27% received veno‐arterial extracorporeal membrane oxygenation (VA ECMO) during Impella support. Two women (13.3%) died, and 13 (87.7%) survived to discharge. Eight women (53.3%) had a recovery of native heart function and six (40%) were bridged to durable left ventricular assist device (LVAD). Conclusion MCS with Impella devices can be successfully used as a bridge to early improvement, heart recovery, or successful implantation of durable LVAD in women with PPCM complicated by severe LV dysfunction.

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“…Only a minority of centers did not routinely decompress the left ventricle (5.6%). Russo et al 21 performed a meta-analysis of 17 observational studies including 3,997 patients supported with VA-ECMO. Overall mortality in the entire cohort was 60%, and a dedicated left ventricular unloading strategy was used in 1696 patients (42%), which included an IABP in 91.7%, percutaneous ventricular assist device in 5.5%, and pulmonary vein or trans-septal left atrial decompression in 2.8%.…”

Section: Implications Of Left Ventricular Distention During Va-ecmomentioning

confidence: 99%

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

Desai

Hwang

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Left Ventricular Unloading During Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock

Cited by 286 publications

References 32 publications

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Use of Impella heart pump for management of women with peripartum cardiogenic shock

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

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