Should ECMO be used in cardiogenic shock?

Gokalp, Orhan; Dönmez, Köksal; İner, Hasan; Gökalp, Gamze; Besir, Yuksel; Yeşilkaya, Nihan Karakaş; Yilik, Levent; Gürbüz, Ali

doi:10.1186/s13054-019-2453-2

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…However, the left atrial pressure remains high as the left ventricle contracts, and diastolic function is seriously impaired, resulting in excessive LV preload and LVEDP [ 15 ]. Elevating ECMO flow is not a good strategy for decreasing preload because a high blood flow rate can injure blood cells and the increase in retrograde perfusion flow further increases the LV afterload [ 9 , 16 ]. At this time, ECMO combined with decompression therapy such as IABP or ECMO combined other LV decompression techniques can effectively reduce LV afterload and balance the left and right heart filling.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, ECMO can only help cardiogenic shock patients achieve LV function but cannot improve LV function during left ventricular (LV) failure. However, VA-ECMO often increases left ventricular afterload and increases the stress on an already dysfunctional left ventricle [ 9 , 10 ]. This phenomenon results in retrograde aortic flow that can increase left ventricular end-diastolic pressure (LVEDP), which leads to severe pulmonary edema and increased wall stress and myocardial oxygen consumption, ultimately impairing myocardial recovery and increasing mortality.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

et al. 2020

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Background Left ventricular decompression is the primary method for solving VA-ECMO-induced LV afterload increase, but the effect of specific methods on patient outcomes and complications is unknown. Material/Methods We searched for all published reports conducted in patients undergoing ECMO combined with LVD. Statistical analyses were performed using Stata 12.0. Results The results showed that the risk of death with ECMO combined with LVD was 29% lower than that with ECMO alone (OR=0.71, 95% CI: 0.56–0.89, I 2 =59.5%, P < 0.001 ). Although the risk of death with ECMO combined other LV decompression techniques was higher than that with ECMO combined with IABP, the difference was not statistically significant (OR=1.27, 95% CI: 0.86–1.87, I 2 =44.0%, P = 0.057 ). In addition, the ORs values of hemorrhage, stroke/acute episodes, lower-limb ischemia, and hemolysis for ECMO combined with LVD were 0.69 (0.66–0.71), 0.82 (0.78–0.89), 0.71 (0.30–1.66), and 0.48 (0.16–1.39), respectively. The risk of complications, such as stroke/TIA, limb ischemia, and hemolysis, of ECMO combined with IABP was lower than that of ECMO combined other LV decompression techniques, and the risk of bleeding was higher for ECMO combined with IABP. Conclusions ECMO combined with LVD is more beneficial than using ECMO alone and helps to lower patient mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

et al. 2020

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“…Use of LEFT ventricular assist devices, Impella, also has proven to be an effective strategy to unload such ventricle. [8][9][10][11] e clinical and echocardiographic contraindications are as mentioned in [Tables 3 and 4]. In septic patient, initiation of ECMO is controversial even in the presence of cardiogenic shock due to presence of conduit bacteremia, inflammation, and bleeding diathesis in septic patients with disseminated intravascular coagulopathy.…”

Section: Cardiopulmonary Resuscitation Along With Ecmo (E-cprmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review

Nambiar

Sharma

Mehta

2023

JCCC

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Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.

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“…The peripherally implemented ECMO system transfers blood into the aorta in the opposite direction to the blood ejected from the LV. Consequently, and as in the case our patient, it increases the afterload of the damaged LV, which can cause aortic valve closure, intraventricular blood retention, and LV distension [ 8 , 9 ]. Such a state generates excessive LV wall tension, diminishes coronary flow and increases the risk of intraventricular clotting formation.…”

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confidence: 99%

Concomitant use of veno-arterial extracorporeal membrane oxygenation and Impella in the intensive care unit: a case report of fulminant myocarditis with multi-organ failure

Gawda¹,

Marszalski²,

Sacha³

et al. 2020

ait

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We would like to present a case of a young male patient with fulminant myocarditis and multi-organ failure treated in our intensive care unit. In the early phase of the treatment, we simultaneously applied mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (ECMO). The use of short-term MCS devices in fulminant myocarditis and in other forms of severe heart failure has increased in recent years [1]. The results of some clinical trials indicate that this mode of treatment, when applied in the early phase of cardiogenic shock, yields promising final results [2,3].A 27-year old, previously healthy man was admitted to the Emergency Department with dyspnea, chest pain, and arterial hypotension. He had been suffering from flu-like syndrome for a week prior to admission. Upon hospital arrival, his mean arterial pressure was 50 mm Hg, and the heart rate was 120 beats per minute. Transthoracic echocardiogram (TTE) revealed severe dysfunction of both ventricles with 15% left ventricular (LV) ejection fraction (EF), 8 cm s -1 velocity-time integral of the left ventricle outflow track (LVOT VTI), and 12 mm tricuspid annular plane systolic excursion (TAPSE). Laboratory tests showed troponin above

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Should ECMO be used in cardiogenic shock?

Cited by 4 publications

References 8 publications

Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review

Concomitant use of veno-arterial extracorporeal membrane oxygenation and Impella in the intensive care unit: a case report of fulminant myocarditis with multi-organ failure

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