The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support

Early left ventricular unloading via active transseptal left atrial venting in case of cardiogenic shock under veno‐arterial extracorporeal membrane oxygenation: A meta‐analysis

“…To address these side effects and to facilitate VA-ECMO weaning, experts recommend early consideration of LV unloading after VA-ECMO initiation (class II, level C), without specifying the ideal strategy or optimal timing for implementation. 2 One of the main strategies consists in left atrial (LA) venting either passive via an atrioseptostomy, or active via a cannula inserted through the interatrial septum and connected in 'y' to the venous line of the ECMO.…”

Response by Ostadal and Belohlavek to Letter Regarding Article, “Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial”

“…2 Perhaps an even more important point mentioned by Dr Ferreira is the definition of cardiogenic shock as a cardiac pump failure with low cardiac output leading to systemic hypoperfusion. This definition is compliant, eg, with the recent guideline of the International Society for Heart and Lung Transplantation and Heart Failure Society of America on acute mechanical circulatory support, 3 but differs from many other guidelines defining cardiogenic shock on the basis of the presence of hypotension. Low blood pressure in this context is only a surrogate marker that may or may be not associated with low cardiac output even in the presence of left ventricular systolic dysfunction.…”

The Blood Crown Princess: Family‐centered care of a parent on mechanical support

“…A 40-year-old patient admitted in cardiogenic shock required VA-ECMO and urgent advanced heart failure therapies evaluation for durable LVAD or heart transplantation. Palliative Care consultation is a recommended part of this evaluation, 2 and we identified that the patient's eight-year-old son was her motivation to accept invasive procedures. She was declined for advanced therapies due to recent substance use, and her transition from ECMO to temporary Impella support was complicated by RV failure requiring unplanned temporary RVAD support.…”