Nonejecting Hearts on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation: Aortic Root Blood Stasis and Thrombus Formation—A Case Series and Review of the Literature

Hireche-Chikaoui, Hanane; Grübler, Martin; Bloch, Andreas; Windecker, Stephan; Bloechlinger, Stefan; Hunziker, Lukas

doi:10.1097/ccm.0000000000002966

Cited by 33 publications

(7 citation statements)

References 31 publications

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“…Lemor et al (14) also found higher rates of ischemic stroke in the ECMO cohort. This could potentially be explained by the well-established phenomenon of blood stasis in the aortic root leading to thrombus formation in the context of poor LV contractility and high systemic perfusion pressure in ECMO patients (36). In addition, in cases of poor pulmonary function, Harlequin syndrome (also known as north-south syndrome) may occur in approximately 9% of patients on ECMO, in which unoxygenated blood perfuses the brain, potentially leading to higher rates of ischemic stroke in such patients (37).…”

Section: Discussionmentioning

confidence: 99%

Impella Versus Extracorporeal Membrane Oxygenation in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Abusnina

Ismayl

Al‐Abdouh

et al. 2022

Shock

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Background: Cardiogenic shock (CS) carries high mortality. The roles of specific mechanical circulatory support (MCS) systems are unclear. We compared the clinical outcomes of Impella versus extracorporal membrane oxygenation (ECMO) in patients with CS. Methods: This is a systematic review and meta-analysis that was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Cochrane Central Register, Embase, Web of Science, Google Scholar, and ClinicalTrials.gov (inception through May 10, 2022) for studies comparing the outcomes of Impella versus ECMO in CS. We used random-effects models to calculate risk ratios (RRs) with 95% confidence interval (CIs). End points included in-hospital, 30-day, and 12-month all-cause mortality, successful weaning from MCS, bridge to transplant, all reported bleeding, stroke, and acute kidney injury. Results: A total of 10 studies consisting of 1,827 CS patients treated with MCS were included in the analysis. The risk of in-hospital all-cause mortality was significantly lower with Impella compared with ECMO (RR, 0.80; 95% CI, 0.65–1.00; P = 0.05), whereas there was no statistically significant difference in 30-day (RR, 0.97, 95% CI, 0.82–1.16; P = 0.77) and 12-month mortality (RR, 0.90; 95% CI, 0.74–1.11; P = 0.32). There were no significant differences between the two groups in terms of successful weaning (RR, 0.97; 95% CI, 0.81–1.15; P = 0.70) and bridging to transplant (RR, 0.88; 95% CI, 0.58–1.35; P = 0.56). There was less risk of bleeding and stroke in the Impella group compared with the ECMO group. Conclusions: In patients with CS, the use of Impella is associated with lower rates of in-hospital mortality, bleeding, and stroke than ECMO. Future randomized studies with adequate sample sizes are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Impella Versus Extracorporeal Membrane Oxygenation in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Abusnina

Ismayl

Al‐Abdouh

et al. 2022

Shock

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“…Aortic root thrombi have been reported in patients on VA ECMO because of LV nonejection and stasis in the root. 11 Patients with VSDs on VA ECMO are likely at greater risk for aortic root thrombus because of pressure gradients favoring increased flow through the VSD rather than the AV, with potentially devastating embolic complications, including stroke. This complication can be recognized promptly by echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

Sharma

Beale

Ehsan

et al. 2020

CASE

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“…Therefore, if during the acute phase of VA-ECMO implantation the "dose" is a critical factor to recovery the end-organ function, the complementary goal is to reduce the biologic impact of support and favor myocardial healing. Many data are emerging in support of a role of myocardial unloading to reach this aim [28]. Data coming out from experimental data on animal and computer simulations seem to support the hypothesis that ventricular unloading is more effective than atrial unloading.…”

Section: Destination Of Va-ecmomentioning

confidence: 97%

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

Amarelli¹,

Musumeci²,

Loforte³

et al. 2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) still carries an unacceptably high mortality (30-60%), despite several therapeutic approaches; the SHOCK II trial questioned the benefit of intra-aortic balloon pump (IABP), while IMPRESS and CULPRIT-SHOCK trials confirmed heterogeneity in disease spectrum and patient selection for acute myocardial infarction-related CS requiring acute mechanical circulatory support (AMCS). The heterogeneity of devices employed as AMCS, including temporary micro-axial flow pumps (Impella), percutaneous bypass (TandemHeart), and extracorporeal life support (VA-ECMO), contributed to the actual dramatic scenario, where CS is defined clinically rather than hemodynamically. To date, the role of VA-ECMO is emerging as rapid strategy to mitigate mortality rates of severe refractory states, despite the lack of data regarding the best practices of management and flows control. VA-ECMO's flow represents the "dose" of treatment and higher flows are less tolerated percutaneously requiring, to prevent deleterious pulmonary edema and ventricular distention, additional approaches such as pulmonary, left atrial, or left ventricular unloading. Any efforts have to be directed to (1) determine adequate management of patients on VA-ECMO, (2) define the safer duration of VA-ECMO support, and (3) establish algorithms and techniques to predict and obtain stable weaning from ECMO or ensure fast transition to durable VAD and/or heart transplant.

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Nonejecting Hearts on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation: Aortic Root Blood Stasis and Thrombus Formation—A Case Series and Review of the Literature

Cited by 33 publications

References 31 publications

Impella Versus Extracorporeal Membrane Oxygenation in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Impella Versus Extracorporeal Membrane Oxygenation in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

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