Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*

Combes, Alain; Leprince, Pascal; Luyt, Charles‐Édouard; Bonnet, Nicolas; Trouillet, Jean‐Louis; Léger, Philippe; Pavie, Alain; Chastre, Jean

doi:10.1097/ccm.0b013e31816f7cf7

Cited by 568 publications

(425 citation statements)

References 36 publications

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“…Első vonalbeli alkalmazásához szükséges ismeretek szívsebészeti, invazív kardiológiai gyakorlattal könnyedén elsajátíthatók, ára az IABP-vel összevethető nagyságrendű. A közelmúltban megjelent publikációk kedvező korai tapasztalatokról számolnak be [9,10,11]. Fontos megjegyezni ugyanakkor, hogy az ECMO-kezelés komplex terápiás modalitás, és a siker nagy tapasztalatot és szervezettséget igényel.…”

Section: Ecmo Alkalmazása Akut Infarktusban Infarktus "Hub"-ok Kialaunclassified

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

et al. 2015

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Bevezetés: Magyarországon 2012-ben ünnepelte 20 éves évfordulóját a szívtranszplantáció, ám a mechanikus keringéstámogató eszközök ezalatt az idő alatt a végstádiumú szívelégtelenség korszerű terápiájának hiányzó láncsze-mét alkották. 2012 májusában, a Semmelweis Egyetem Szív-és Érgyógyászati Klinikáján átadott szívtranszplantációs és szívelégtelenség intenzív osztály, valamint az ehhez társuló eszközfejlesztések tették lehetővé a műszívprogram elindulását. Célkitűzés: A szerzők a program tapasztalatairól számolnak be. Módszer: 2012 májusa és 2014 decembere között 72 beteget 89 esetben kezeltek mechanikus keringéstámogató eszközökkel. A támogatás indikációja valamennyi esetben terápia refrakter végstádiumú szívelégtelenség, illetve akut bal-vagy jobbszívfél-elégtelenség volt. Eredmények: Huszonhét esetben szívtranszplantáció utáni akut graftelégtelenség, 24 esetben súlyos végstádiumú szívelégtelenség, 21 esetben akut infarktus, 14 esetben szívműtét utáni akut balszívfél-elégtelenség, két esetben sú-lyos légzési elégtelenség, egy esetben gyógyszermérgezés következtében kialakult malignus ritmuszavar miatt kezdték el a terápiát. A teljes program 30 túlélő betege közül 13 került sikeres szívtranszplantációra. Következtetések: A rendelkezésre álló sokoldalú műszerparkkal a ma létező valamennyi lehetséges terápiás modalitás megvalósítható a rövid távú keringéstámogatástól a középtávú támogatáson át a szívtranszplantációig vagy a végleges műszívbeül-tetésig. Orv. Hetil., 2015, 156(13), 521-527.Kulcsszavak: mechanikus keringéstámogatás, műszív, szívtranszplantáció, VAD, ECMO Mechanical circulatory support saves lives -three years' experience of the newly established assist device program at Semmelweis UniversityIntroduction: Since the celebration of the 20th anniversary of the fi rst heart transplantation in Hungary in 2012 the emerging need for modern heart failure management via mechanical circulatory support has evolved. In May 2012 the opening of a new heart failure and transplant unit with 9 beds together with the procurement of necessary devices at Semmelweis University accomplished this need. Aim: The aim of the authors was to report their initial experience obtained in this new cardiac assist device program. Method: Since May, 2012, mechanical circulatory support system was applied in 89 cases in 72 patients. Indication for support were end stage heart failure refractory to medical treatment and acute left or right heart failure. Results: Treatment was initiated for acute graft failure after heart transplantation in 27 cases, for end stage heart failure in 24 cases, for acute myocardial infarction in 21 cases, for acute postcardiotomy heart failure in 14 cases, for severe respiratory insuffi ciency in 2 cases and for drug intoxication in one case. Among the 30 survivor of the whole program 13 patients were successfully transplanted. Conclusions: The available devices can cover all modalities of current bridge therapy from short term support through medium support to heart transplantation or long term support an...

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Section: Ecmo Alkalmazása Akut Infarktusban Infarktus "Hub"-ok Kialaunclassified

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

et al. 2015

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“…2). The group in La Pitié, Paris, which is one of the most experienced centres in ECMO therapy, retrospectively examined 81 patients who were put on ECMO for cardiogenic shock due to medical, postcardiotomy or posttransplantation heart failure [5]. The analysis showed a 42% survival to h ospital discharge and a 38% survival a t survival from refractory cardiogenic shock requiring ECMO [6].…”

Section: Early Survivalmentioning

confidence: 99%

“…More than half of all patients develop one or more major ECMO-related complication [5]. of patients [5,7,9,12].…”

Section: Vascularmentioning

confidence: 99%

Extracorporeal membrane oxygenation for acute cardiogenic shock

2016

Cardiovasc Med

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SummaryVeno-arterial extracorporeal membrane oxygenation (ECMO) is utilised as a short-term mechanical circulatory assist device for treatment of refractory acute cardiogenic shock. After a period of support, called "bridge to decision", the options for ensuing therapy include weaning from ECMO, switch to a long-term ventricular assist device, or heart transplantation, depending on the occurrence of myocardial recovery and the presence of and renal adverse events, as well as from the particular circumstances of cardiogenic shock. The condition triggers a cascade of systemic inflammation, which is aggravated depending on the duration of the hypotensive period. The extent of the subsequent multiorgan dysfunction syndrome substantially affects outcome. As a consequence, early ECMO implantation is advocated. In unclear neurological conditions and severely compromised e nd-organ function, t he a nticipated poor outcome has to be weighed very carefully against ethical and economical aspects before ECMO is initiated.

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“…4) Balancing the invasiveness of LVAS implantation and subsequent clinical recovery under ECMO support, appropriate timing for switching from initial ECMO to LVAS must be considered. Although some reports have identified the factors correlated with ECMO weaning, 1,5) we must be aware of their limitations: clinical parameters with only 'statistically' significant differences during longstanding intervals, are not as 'clinically' sig- (1-7). The flexion points of ETCO 2 prior to ECMO weaning (E-point in Figure 1, solid triangle) were indicated by an initial increase in ETCO 2 of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours.…”

Section: Clinical Implication Of Recovery Time Point Using Etcomentioning

confidence: 99%

“…1,2) Although setting up the equipment is easy, a quick overall methodology during management has not been fully established. There have been few guidelines concerning its utilization in relation to the treatment of fulminant myocarditis.…”

mentioning

confidence: 99%

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

et al. 2010

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SummaryAlthough extracorporeal membrane oxygenation (ECMO) is widely used as temporary circulation support, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning off.Twenty-five patients supported by ECMO due to hemodynamic deterioration were divided into 2 groups according to their outcome: weaned ECMO (W: n = 18) or not (NW: n = 7). In the W group, we examined the differences in parameters between the 2 time points, ECMO introduction, and the reduction in ECMO flow to 40% of the initial setting known as the conventional recovery point (C-point). Significant differences were observed in systolic pulmonary artery pressure, the cardiac index measured by the thermodilution method, C-reactive protein, lactate, base excess, and the end-tidal CO 2 concentration (ETCO 2 ). Next, by closely examining these 6 parameters measured every 12 hours, we found that only ETCO 2 had always changed steeply, like a 'flexion point' (E-point), in all W cases, but not in NW. The E-point was defined as an initial increase in ETCO 2 of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours. E-points appeared as much as 95 ± 60 hours earlier than C-points and also preceded weaning off of ECMO.ETCO 2 can be a useful continuous parameter for predicting the adequate timing of weaning off of ECMO for circulatory failure at the bedside. (Int Heart J 2010; 51: 116-120) Key words: End-tidal carbon dioxide, Extracorporeal membrane oxygenation, Hemodynamic deterioration, Clinical predictor, Weaning E xtracorporeal membrane oxygenation (ECMO) is widely used not only for temporary cardiopulmonary support in cases of hemodynamic deterioration, but also in bridge therapy for left ventricular assist system (LVAS) as well as cardiac transplantation.1,2) Although setting up the equipment is easy, a quick overall methodology during management has not been fully established. There have been few guidelines concerning its utilization in relation to the treatment of fulminant myocarditis.3) The guidelines say, for example, that ECMO flow of 3-3.5 L/min initially should be reduced gradually with improved cardiac function to around 1.0 L/min, followed by weaning off. As for the predictive indicators, resultant ECMO flow fell to about 40% of the initial flow, implying cardiac recovery, and patients can subsequently be weaned off ECMO.3) Under conventional methodology using 'trial and error' as described above, however, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning patients off ECMO. In this study, we focused on clinical variables measured continuously at the patient's bedside, especially the end-tidal carbon dioxide concentration (ETCO 2 ), to determine the appropriate time to wean patients off ECMO. MethodsPatient population and clinical classification: Thirty-seven consecutive patients with cardiovascular disorders treated with ECMO at our institution between 1996-2008 were investigated. We excluded patients in whom ECMO wa...

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Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*

Cited by 568 publications

References 36 publications

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

Extracorporeal membrane oxygenation for acute cardiogenic shock

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

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Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock*

Cited by 568 publications

References 36 publications

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

Mechanical circulatory support saves lives – three years’ experience of the newly established assist device program at Semmelweis University

Extracorporeal membrane oxygen­ation for acute cardiogenic shock

End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

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Extracorporeal membrane oxygenation for acute cardiogenic shock