Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography

Cavarocchi, Nicholas C.; Pitcher, Harrison T.; Yang, Qiong; Karbowski, Pawel; Miessau, Joseph; Hastings, Harold M.; Hirose, Hitoshi

doi:10.1016/j.jtcvs.2013.06.055

Cited by 144 publications

(147 citation statements)

References 21 publications

(33 reference statements)

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“…When the patient had clinically improved, a weaning trial was performed at the bedside using the protocol previously described (15). If the patient tolerated the trial satisfactorily, the patient was taken to the operating room for decannulation.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

Tanaka

Hirose

Cavarocchi

et al. 2016

The Annals of Thoracic Surgery

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138

124

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Section: Methodsmentioning

confidence: 99%

The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

Tanaka

Hirose

Cavarocchi

et al. 2016

The Annals of Thoracic Surgery

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138

124

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“…Although there is no standardized weaning protocol in the setting of RV dysfunction secondary to PH, one can adapt protocols from weaning VA-ECMO and RV assist devices used in other scenarios. [44][45][46] Typically, the ECMO flow rate is decreased by 0.5 L/min with observation of the systemic blood pressure, PA pressure, central venous pressure, heart rate, and heart rhythm. Mixed venous oxygen saturation and systemic Pao 2 levels may also inform clinical decision making.…”

Section: Clinical Experience With Chronic Thromboembolic Pulmonary Hymentioning

confidence: 99%

“…Puente a la recuperación post-endarterectomía pulmonar ECMO-VV función VD secundaria a HP, pueden adaptarse protocolos de desconexión de ECMO VA y dispositivos de asistencia VD usados en otros escenarios. [44][45][46] Comúnmente, el caudal de la ECMO se reduce 0,5 L/min observando la presión arterial sistémica, la presión de la AP, la presión venosa central, la frecuencia cardíaca y el ritmo cardíaco. La saturación de oxígeno venoso mixto y los niveles sistémicos de Pao 2 también pueden proporcionar información para la toma de decisiones clínicas.…”

Section: Experiencia Clínica Con La Hipertensión Pulmonar Tromboembólunclassified

Mechanical Support for the Failing Right Ventricle in Patients With Precapillary Pulmonary Hypertension

Machuca

Perrot

2015

Circulation

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526R ight ventricular (RV) dysfunction is the principal predictor of adverse outcome in pulmonary hypertension (PH).1,2 For those PH patients requiring inpatient intensive care because of acutely decompensated heart failure, mortality estimates can range as high as 30% to 48%. [3][4][5] Hyponatremia, renal insufficiency, systemic hypotension, and severe tricuspid regurgitation are worrisome clinical characteristics that prognosticate poor outcome in this PH patient subpopulation. 3,5,6 Effective strategies to optimize cardiopulmonary hemodynamics and support RV function are paramount; clinical responsiveness to pulmonary vascular/RV-specific treatment is likely to decrease the probability of requiring surgical intervention and, ultimately, improve outcome. This review will discuss existing evidence pertaining to the timing and utility of mechanical support in patients with RV failure attributable to pulmonary vascular disease. Pathophysiology of RV Failure in PHConstrictive pericardial disease, selected forms of congenital heart disease, inflow obstruction, primary myocardial disease, and pressure or volume overload are each well-described causes of adverse RV remodeling, RV systolic dysfunction, and cor pulmonale.7 Among patients with RV dysfunction as a result of pressure overload, precapillary PH and left-sided heart failure are the most common etiologies.The first adaptive response of the RV to pressure overload is hypertrophy. If untreated, the RV dilates to compensate for increased RV preload and, according to the Frank-Starling principle, to maintain stroke volume. When further increases in RV end-diastolic filling volume do not offset progressive RV contractile dysfunction, clinically evident RV failure ensues. In advanced stages, RV cavitary dilation may also impair left ventricular (LV) diastolic filling kinetics and contribute further to global pump dysfunction and, consequently, to the congestive heart failure syndrome.Mechanical support in the setting of RV dysfunction aims to stabilize and therapeutically improve several key mechanisms underpinning RV decompensation and heart failure by reducing RV preload and afterload, and by improving RV cardiac output, as well. As a consequence of achieving these goals, a number of additional beneficial effects may occur to stabilize RV performance, including (1) decreased pulmonary artery (PA) diameter and prevention of left-sided coronary artery compression 8 ; (2) decreased tricuspid regurgitation attributable to attenuated RV cavitary dilation 9 and improved interventricular septal bowing; and (3) decreased free-wall stress that maintains favorable RV myocardial oxygen demand/perfusion dynamics.10 Addressing the aforementioned contributors to RV failure is conceptually important in the management of RV failure, because, although the RV is less adaptable to pressure overload, it carries a substantial potential of recovery once its afterload is normalized. 11 Mechanical Circulatory Support for the Failing RV: Patient SelectionIf pharmacological therapies a...

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“…The results showed that a short period of training (6 hours) allowed intensivists who previously had no training in TEE before the use the use of hTEE, could highlight the same hemodynamic disturbances as a trained cardiologist [48][49][50]. Regarding clinical use, hTEE usage was proven to have a direct therapeutic bearing in 50 -66% of the critically ill studied patients [50,51]. In cardiac surgical patients, hTEE was better able to identify critical circumstances than the classic hemodynamic techniques, in 66 % of cases [51][52][53].…”

mentioning

confidence: 93%

“…Regarding clinical use, hTEE usage was proven to have a direct therapeutic bearing in 50 -66% of the critically ill studied patients [50,51]. In cardiac surgical patients, hTEE was better able to identify critical circumstances than the classic hemodynamic techniques, in 66 % of cases [51][52][53].…”

mentioning

confidence: 99%

The Diagnosis and Hemodynamic Monitoring of Circulatory Shock: Current and Future Trends

Hendy

Bubenek-Turconi

2016

The Journal of Critical Care Medicine

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Circulatory shock is a complex clinical syndrome encompassing a group of conditions that can arise from different etiologies and presented by several different hemodynamic patterns. If not corrected, cell dysfunction, irreversible multiple organ insufficiency, and death may occur. The four basic types of shock, hypovolemic, cardiogenic, obstructive and distributive, have features similar to that of hemodynamic shock. It is therefore essential, when monitoring hemodynamic shock, to making accurate clinical assessments which will guide and dictate appropriate management therapy. The European Society of Intensive Care has recently made recommendations for monitoring hemodynamic shock. The present paper discusses the issues raised in the new statements, including individualization of blood pressure targets, prediction of fluid responsiveness, and the use of echocardiography as the first means during the initial evaluation of circulatory shock. Also, the place of more invasive hemodynamic monitoring techniques and future trends in hemodynamic and metabolic monitoring in circulatory shock, will be debated.

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Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography

Abstract: The hTEE-guided ECMO weaning protocol accurately predicted the ability to wean ECMO to decision. This protocol can be applied by cardiac intensivists as a part of standard bedside intensive care unit assessment.

Cited by 144 publications

References 21 publications

The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

The Impact of Vascular Complications on Survival of Patients on Venoarterial Extracorporeal Membrane Oxygenation

Mechanical Support for the Failing Right Ventricle in Patients With Precapillary Pulmonary Hypertension

The Diagnosis and Hemodynamic Monitoring of Circulatory Shock: Current and Future Trends

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