Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Lorusso, Roberto; Centofanti, Paolo; Gelsomino, Sandro; Barili, Fabio; Mauro, Michele Di; Parise, Orlando; Botta, Luca; Milazzo, Filippo; Dato, Guglielmo Mario Actis; Casabona, Riccardo; Casali, Giovanni; Musumeci, Francesco; Bonis, Michele De; Zangrillo, Alberto; Alfieri, Ottavio; Pellegrini, Carlo; Mazzola, S.; Coletti, Giuseppe; Vizzardi, Enrico; Bianco, Roberto; Gerosa, Gino; Massetti, Massimo; Caldaroni, Federica; Pilato, Emanuele; Pacini, Davide; Bartolomeo, Roberto Di; Marinelli, Giuseppe; Sponga, Sandro; Livi, Ugolino; Rinaldi, Mauro; Mariscalco, Giovanni; Beghi, Cesare; Miceli, Antonio; Glauber, Mattia; Pappalardo, Federico; Russo, Claudio

doi:10.1016/j.athoracsur.2015.08.014

Cited by 137 publications

(90 citation statements)

References 27 publications

(114 reference statements)

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“…260 For patients with a potentially reversible cause of their CS (eg, acute fulminant myocarditis), outcomes are even better, whereas those with postcardiotomy CS do considerably worse. 261,262 There are no randomized trials assessing the effectiveness of ECMO systems.…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,160

1,055

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,160

1,055

View full text Add to dashboard Cite

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Section: Left Ventricular Unloadingmentioning

confidence: 99%

“…More recently, Lorusso and coworkers analysed through an Italian multi-institutional investigation the results of VA-ECMO in the setting of acute fulminant myocarditis patients (20). The investigators purposely chose a more recent time frame (from January 2008 to December 2013) to assess modern ECMO systems and management, which included advanced VA-ECMO technology and components and more advanced expertise achieved in adult VA-ECMO for emergent cardiovascular diseases.…”

Section: Multi-centre Experiencesmentioning

confidence: 99%

“…Finally, the presence of left ventricular distension is a major limitation to myocardial recovery. In papers providing detailed information left ventricular distension requiring left ventricular unloading is reported between 15% and 30% of peripheral VA-ECMO support for cardiogenic shock due to myocarditis (8,14,17,20,29).When the increase of the inotropic support is not enough to prevent pulmonary edema, left ventricular unloading could be achieved using different techniques:(I) Conversion from peripheral to central VA-ECMO: it is the most invasive but the most effective way to obtain a good left ventricular unloading. A cannula in the right superior pulmonary vein (32) (41) and pulmonary artery cannula (42).…”

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confidence: 99%

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Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Pozzi¹,

Banfı²,

Grinberg³

et al. 2016

J. Thorac. Dis.

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Myocarditis is an inflammatory disease of the heart muscle with established histological, immunological and immunohistochemical diagnostic criteria. Different triggers could be advocated as possible etiologies of myocarditis such as viral and non-viral infections, medications, systemic autoimmune diseases and toxic reactions. The spectrum of clinical presentations of myocarditis is broad and varies from subclinical asymptomatic courses to refractory cardiogenic shock. The prognosis of patients with myocarditis depends mainly on the severity of clinical presentation. In particular, myocarditis patients developing cardiogenic shock refractory to optimal maximal medical treatment may benefit from the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a temporary mechanical circulatory support (MCS).The aim of the present report is to offer a review of the most important articles of the literature showing the results of VA-ECMO in the specific setting of cardiogenic shock due to myocarditis in adult patients. J Thorac Dis 2016;8(7):E495-E502 jtd.amegroups.com characterized by tissue hypoperfusion and multiorgan failure requiring prompt interventions. Initially refractory cardiogenic shock is supported with temporary MCS as a "bridge to decision" before considering the patient eligible for a long-term device implantation in case of no recovery. This general trend has been regularly highlighted by the Annual Reports of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) (4,5). The implantation of long-term MCS in cardiogenic shock patients, i.e., INTERMACS Level 1 patients, fell since 2006 from 41% to 14%. As a consequence, there has been a considerable increase from 8% to 30% in the implantation of long-term MCS in INTERMACS Level 3 patients, i.e., stable but inotrope-dependent heart failure patients. In this subgroup of critically ill and unstable patients in cardiogenic shock, VA-ECMO allows, on the one hand, temporary hemodynamic stabilization with improvement of end-organ function and, on the other hand, gives the time to perform complementary diagnostic exams and to decide the therapeutic strategy in these high-risk candidates for immediate long-term MCS implantation (6). VA-ECMO could be implanted and removed directly at the bedside in the intensive care unit and offers a reasonable solution in term of cost-effectiveness.Patients who do not show myocardial recovery during VA-ECMO support could be directed to longterm ventricular assist device implantation or heart transplantation depending on age, general clinical and functional status, life expectancy and organs function (brain, lung, liver and kidneys). Finally, as stated by the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure, short-term MCS should be considered (as a "bridge to recovery") in patients remaining severely hypoperfused despite inotropic therapy and with a potentially reversible cause (e.g., viral myocarditis) or a potentially ...

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“…In the setting of a reversible insult such as acute fulminant myocarditis, a multicenter analysis demonstrated cardiac recovery and weaning from VA-ECLS in up to 76% of cases with survival to hospital discharge of 72% (6). A single institution series evaluating outcomes of VA-ECLS in the post-cardiac surgery setting in 233 patients demonstrated a lower survival rate to hospital discharge of 36% (7).…”

Section: Discussionmentioning

confidence: 99%

Initiation and management of adult veno-arterial extracorporeal life support

et al. 2017

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Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Cited by 137 publications

References 27 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock due to myocarditis in adult patients

Initiation and management of adult veno-arterial extracorporeal life support

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