Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock

Keebler, Mary; Haddad, Elias V.; Choi, Chun Woo; McGrane, Stuart; Zalawadiya, Sandip; Schlendorf, Kelly; Brinkley, D. Marshall; Danter, Matthew; Wigger, M.; Menachem, Jonathan N.; Shah, Ashish S.; Lindenfeld, Jo Ann

doi:10.1016/j.jchf.2017.11.017

Cited by 180 publications

(169 citation statements)

References 50 publications

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“…66À71 Factors associated with worse outcomes include increasing age, female sex, higher body mass index, ischemic heart disease, diabetes mellitus, chronic renal disease, and chronic obstructive lung disease. 61,65,66,72 The degree of acidosis and severity of end-organ failure at the time of ECMO initiation are also predictors of long-term survival. 61,66,70,72,73 In patients with post-cardiotomy shock, ischemic heart disease and level of arterial lactate before initiation of VA-ECMO were independent risk factors for 90-day mortality.…”

Section: Ecmo For Cardiac Failurementioning

confidence: 99%

“…61,65,66,72 The degree of acidosis and severity of end-organ failure at the time of ECMO initiation are also predictors of long-term survival. 61,66,70,72,73 In patients with post-cardiotomy shock, ischemic heart disease and level of arterial lactate before initiation of VA-ECMO were independent risk factors for 90-day mortality. 74 For patients with acute decompensated chronic systolic heart failure, diabetes mellitus and mineralocorticoid receptor antagonist use were found to be independent predictors of mortality.…”

Section: Ecmo For Cardiac Failurementioning

confidence: 99%

“…72 Initial goals are flow of 50 to 70 mL/kg/min and mean arterial pressure > 60 mmHg. 66 Regardless of high VA-ECMO flow rates, there is still blood that returns to the left ventricle (LV): residual flow from pulmonary circuit, Thebesian drainage of coronary blood flow, flow from any aortic regurgitation, and return of bronchial blood flow to the left atrium. 72 Blood in the LV must exit through the aortic valve, necessitating the struggling LV to eject against arterial pressure that is increased by VA-ECMO flow.…”

Section: Trends In Va-ecmo Usementioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Kwak

Majewski

Jellish

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Ecmo For Cardiac Failurementioning

confidence: 99%

Section: Ecmo For Cardiac Failurementioning

confidence: 99%

Section: Trends In Va-ecmo Usementioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Kwak

Majewski

Jellish

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…It provides mechanical support to circulation as well as an extracorporeal gas exchange when the conventional resuscitation techniques fail [58]. Since its introduction in 1972, its role has been explored in various fields including cardiac arrest [59,60]. ECMO can be a ray of hope for the patients who fail to respond to conventional CPR and helps extend the recovery period for treatable causes of cardiac arrest.…”

Section: Extracorporeal Cpr (Ecpr)mentioning

confidence: 99%

Cardiopulmonary Resuscitation: Recent Advances

Kumar¹,

Yadav²,

Garg³

2020

Sudden Cardiac Death

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Cardiac arrest is the most significant reason for mortality and morbidities worldwide. With a better understanding of the pathophysiology of cardiac arrest, simple adaptations in basic life support to upcoming modifications in postresuscitation care have been proposed by various resuscitation councils throughout the globe. Role of point of care cardiac ultrasound during cardiopulmonary resuscitation (CPR) has been explored and its contribution for identifying reversible causes and its real time management has been explored. A higher blood and tissue oxygenation levels contributed to an increased rate of return of spontaneous circulation (ROSC) which has to lead us to explore more options to increase the oxygenation. Starting from the CPR training, the use of sensors for spirometric feedback in ventilation maneuvers can help improve the quality of CPR. High flow nasal oxygenation during CPR has shown promising results. Extracorporeal CPR is another entity that has shown survival benefits in a selected group of patients. The aim of the newer advances has always been to decrease the morbidity and improve survival outcomes in terms of neurological deficit as well. These guidelines are reviewed and updated regularly to improve knowledge and training based on the current evidence. This chapter shall focus on recent advances in cardiopulmonary resuscitation.

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“…It is associated with immediate improvement in blood pressure and hemodynamics. However, it also results in an increased afterload in an already failing left ventricle (LV) 7‐9 . Many strategies directed at unloading the LV have been attempted, including pulmonary vein or transseptal left atrial cannulation, intra‐aortic balloon pump (IABP), percutaneous mechanical circulatory support, or transapical cannulation.…”

Section: Introductionmentioning

confidence: 99%

Impella to unload the left ventricle in patients undergoing venoarterial extracorporeal membrane oxygenation for cardiogenic shock: A systematic review and meta‐analysis

et al. 2020

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Background and Aim Impella is frequently used to unload the left ventricle in patients with cardiogenic shock on venoarterial extracorporeal membrane oxygenation (VA‐ECMO). There is limited data regarding the use of this strategy. This study aims to evaluate the safety and efficacy of the said strategy. Methods A systematic search for studies comparing Impella plus VA‐ECMO (ECVAD) vs VA‐ECMO alone was performed using Pubmed, Cochrane Library, and Scopus. Studies meeting inclusion criteria were then used to perform a meta‐analysis. Results Three studies involving 448 patients were included in the final analysis. In total, 117 (26%) patients were female, mean age was 57 years. VA‐ECMO was placed in 355 out of 448 (79%) patients, while ECVAD was placed in 93 out of 448 (21%). Death occurred in 49 out of 93 (52.6%) patients on ECVAD and 226 out of 355 (63.6%) on ECMO, relative risk (RR): 0.76, confidence interval (CI), 95% (0.62‐0.94) P = .01. Hemolysis was present in 46 (49.4%) patients in the ECVAD vs 67 (18%) in the ECMO group, RR: 2.64, CI, 95% (1.97–3.55) P < .01. Bleeding was present in 42 (45.2.%) patients in the ECVAD group and 135 (38%) in the ECMO group, RR: 1.25, CI, 95% (0.95‐1.63) P = .11. CVVHD was used on 31 (33.3%) patients in the ECVAD group while 89 (25%) in the ECMO group, RR 1.35, CI, 95% (0.95‐1.91) P = .10. Conclusion This study suggests that the use of Impella as an unloading strategy in patients with VA‐ECMO decreased mortality, increased rate of hemolysis, neutral bleeding risk, and similar rates of acute kidney injury requiring CVVHD.

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Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock

Cited by 180 publications

References 50 publications

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Cardiopulmonary Resuscitation: Recent Advances

Impella to unload the left ventricle in patients undergoing venoarterial extracorporeal membrane oxygenation for cardiogenic shock: A systematic review and meta‐analysis

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