Temporary circulatory support with extra corporeal membrane oxygenation in adults with refractory cardiogenic shock

Lidén, Hans; Wiklund, Lars; Haraldsson, Åsa; Berglin, E; Hultman, Jan; Dellgren, Göran

doi:10.1080/14017430802596420

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…This has also been described in two other studies by Wu et al [10] and Lidén et al [11]. They reported 88% 3-year and 100% 5-year survival, respectively, of those patients who survived until hospital discharge following ECMO f or nonpostcardiotomy cardio genic shock or cardiac arrest [10,11].…”

Section: Long-term Resultssupporting

confidence: 58%

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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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Section: Long-term Resultssupporting

confidence: 58%

“…The fact that cardiogenic shock is not just a compro- interval has been shown to be a risk factor for mortality [5,11]. This was most clearly shown in the extreme case scenario of the cardiogenic shock spectrum, namely ongoing CPR treated with ECMO (ECPR) [23].…”

Section: Concluding Commentmentioning

confidence: 89%

Extracorporeal membrane oxygenation for acute cardiogenic shock

2016

Cardiovasc Med

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“…Several studies reported the mean time of ECMO duration ranging between 1.7 and 7.1 days (7,12,13,18–27). In our experience, the mean time of ECMO duration was 10.2 ± 7.3 days (range, 2–34 days).…”

Section: Discussionmentioning

confidence: 49%

Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

et al. 2012

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The novel Permanent Life Support (PLS; Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) as peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support system has been investigated as treatment for patients with refractory cardiogenic shock (CS). Between January 2007 and July 2011, 73 consecutive adult patients were supported on peripheral PLS ECMO system at our institution (55 men; age 60.3 ± 11.6 years, range: 23-84 years). Indications for support were failure to wean from cardiopulmonary bypass in the setting of postcardiotomy (n = 50) and primary donor graft failure (n = 8), post-acute myocardial infarction CS (n = 12), and CS on chronic heart failure (n = 3). Mean support time was 10.9 ± 7.6 days (range: 2-34 days). Overall, 26 (35.6%) patients died on ECMO. Among survivors on ECMO, 44 (60.2%) patients were successfully weaned from support, and three (4.1%) were switched to a mid-long-term ventricular assist device. Thirty-three (45.2%) were successfully discharged. The following variables were significantly different if survivors and nonsurvivors on ECMO were compared: age (P = 0.04), female gender (P < 0.01), cardiopulmonary resuscitation before ECMO (P < 0.01), lactate level before ECMO (P = 0.01), number of platelets, fresh frozen plasma units, and packed red blood cells (PRBCs) transfused during ECMO support (P = 0.03, P = 0.02, and P < 0.01), blood lactate level (P = 0.01), and creatine kinase isoenzyme MB (CK-MB) relative index 72 h after ECMO initiation (P < 0.001), and multiple organ failure on ECMO (P < 0.01). Stepwise logistic regression identified blood lactate level and CK-MB relative index at 72 h after ECMO initiation, and number of PRBCs transfused on ECMO as significant predictors of mortality on ECMO (P = 0.011, odds ratio [OR] = 2.48; 95% confidence interval [CI] = 1.11-3.12; P = 0.012, OR = 2.81, 95% CI = 1.026-2.531; and P = 0.012, OR = 1.94, 95% CI = 1.02-5.21; respectively). Patients with an initial poor hemodynamic status could benefit by rapid peripheral installation of PLS ECMO. The blood lactate level, CK-MB relative index, and PRBCs transfused should be strictly monitored during ECMO support.

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“…Bakhtiary et al (22) transfused 16.3 units of packed RBCs over an average of 6.3 day during ECMO. Patients with post-cardiotomy and non-cardiotomy received transfusions of 23.3 and 17.3 units of packed RBCs over an average of 5.5 and 11.6 day on ECMO, respectively (23). In the present study, the incidence of bleeding complications in the nafamostat mesilate group was significantly less than in the heparin group because 1.6 units/day of packed RBCs were transfused in the nafamostat mesilate group compared to 7.5 units/day in the heparin group.…”

Section: Discussionmentioning

confidence: 99%

Use of Nafamostat Mesilate as an Anticoagulant during Extracorporeal Membrane Oxygenation

Han

Kim

et al. 2011

J Korean Med Sci

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Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.

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Temporary circulatory support with extra corporeal membrane oxygenation in adults with refractory cardiogenic shock

Abstract: Mortality for patients in cardiogenic shock is very high. Treatment with ECMO in patients with refractory cardiogenic shock can be performed with good survival especially in non-surgical patients.

Cited by 21 publications

References 15 publications

Extracorporeal membrane oxygenation for acute cardiogenic shock

Extracorporeal membrane oxygenation for acute cardiogenic shock

Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

Use of Nafamostat Mesilate as an Anticoagulant during Extracorporeal Membrane Oxygenation

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Temporary circulatory support with extra corporeal membrane oxygenation in adults with refractory cardiogenic shock

Abstract: Mortality for patients in cardiogenic shock is very high. Treatment with ECMO in patients with refractory cardiogenic shock can be performed with good survival especially in non-surgical patients.

Cited by 21 publications

References 15 publications

Extracorporeal membrane oxygen­ation for acute cardiogenic shock

Extracorporeal membrane oxygen­ation for acute cardiogenic shock

Peripheral Extracorporeal Membrane Oxygenation System as Salvage Treatment of Patients With Refractory Cardiogenic Shock: Preliminary Outcome Evaluation

Use of Nafamostat Mesilate as an Anticoagulant during Extracorporeal Membrane Oxygenation

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Extracorporeal membrane oxygenation for acute cardiogenic shock

Extracorporeal membrane oxygenation for acute cardiogenic shock