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Post Cardiotomy Shock

Maya Guglin, Mark J Zucker, Vanessa M Bazan, Biykem Bozkurt, Aly El Banayosy, Jerry D Estep, John Gurley, Karl Nelson, Rajasekhar Malyala, Gurusher S Panjrath, Joseph B Zwischenberger, Sean P Pinney
Venoarterial extracorporeal membrane oxygenation (ECMO) is a rescue therapy that can stabilize patients with hemodynamic compromise, with or without respiratory failure, for days or weeks. In cardiology, the main indications for ECMO include cardiac arrest, cardiogenic shock, post-cardiotomy shock, refractory ventricular tachycardia, and acute management of complications of invasive procedures. The fundamental premise underlying ECMO is that it is a bridge-to recovery, to a more durable bridge, to definitive treatment, or to decision...
February 19, 2019: Journal of the American College of Cardiology
Valeria Lo Coco, Roberto Lorusso, Giuseppe M Raffa, Pietro Giorgio Malvindi, Michele Pilato, Gennaro Martucci, Antonio Arcadipane, Kamil Zieliński, Piotr Suwalski, Mariusz Kowalewski
Extracorporeal membrane oxygenation (ECMO) is life-saving for potentially reversible heart failure and respiratory injuries not responsive to conventional therapies. Technological innovations have produced over the years significant improvements in ECMO devices (pump, cannula design and oxygenator) and have allowed a better risk/benefit profile. Alongside with recognized advantages in the treatment of very sick patients, ECMO remains an invasive procedure for mechanical circulatory support (MCS) and it is associated with complications that strongly influence the prognosis...
December 2018: Journal of Thoracic Disease
Chris Oscier, Chinmay Patvardhan, Florian Falter, Will Tosh, John Dunning, Pedro Catarino, Ravi DeSilva, Martin Besser, Kamen Valchanov
Central venoarterial extracorporeal membrane oxygenation has been used since the 1970s to support patients with cardiogenic shock following cardiac surgery. Despite this, in-hospital mortality is still high, and although rare, thrombus within the cardiac chambers or within the extracorporeal membrane oxygenation circuit is often fatal. Aprotinin is an antifibrinolytic available in Europe and Canada, though not currently in the United States. Due to historical safety concerns, use of aprotinin is generally limited and is commonly reserved for patients with the highest bleeding risk...
February 2, 2019: Perfusion
Philip Fernandes, Michael O'Neil, Samantha Del Valle, Anita Cave, Dave Nagpal
A 44-year-old male with ongoing chest pain and left ventricular ejection fraction <20% was transferred from a peripheral hospital with intra-aortic balloon pump placement following a non-ST-elevation myocardial infarction (STEMI). The patient underwent emergent multi-vessel coronary artery bypass grafting requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) on post-operative day (POD)#9 secondary to cardiogenic shock with biventricular failure. Due to clot formation, an oxygenator change-out was necessary shortly after initiation...
December 25, 2018: Perfusion
Guillaume Guimbretière, Amedeo Anselmi, Antoine Roisne, Bernard Lelong, Hervé Corbineau, Thierry Langanay, Erwan Flécher, Jean-Philippe Verhoye
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an accepted and reliable technique to provide temporary circulatory and/or respiratory support. Our objective was to describe the transfusion requirements in ECMO recipients. Secondarily, we addressed the effect of indications for ECMO on transfusion requirements and the baseline factors associated with worse survival. METHODS: We reviewed the prospectively collected data of 509 patients receiving venoarterial (VA) or venovenous (VV) ECMO therapy (2005-2016)...
November 16, 2018: Perfusion
Mark Anderson, D Lynn Morris, Daniel Tang, George Batsides, Ajay Kirtane, Ivan Hanson, Perwais Meraj, Navin Kumar Kapur, William O'Neill
BACKGROUND: Right ventricular failure (RVF) after myocardial infarction, cardiotomy, or left ventricular assist device (LVAD) implantation increases morbidity and mortality. RVF also contributes to prolonged length of hospital stay and higher costs of care. The aim of this study was to evaluate the efficacy and safety of the Impella RP (Abiomed, Danvers, MA) in patients with severe RVF in these clinical settings. METHODS: This is a prospective cohort study of patients with severe RVF treated with a percutaneous right ventricular assist device (RVAD)...
December 2018: Journal of Heart and Lung Transplantation
Martin Chen, Adam Evans, Jacob Gutsche
No abstract text is available yet for this article.
October 2018: Journal of Cardiothoracic and Vascular Anesthesia
Giuseppe Maria Raffa, Mariusz Kowalewski, Daniel Brodie, Mark Ogino, Glenn Whitman, Paolo Meani, Michele Pilato, Antonio Arcadipane, Thijs Delnoj, Eshan Natour, Sandro Gelsomino, Jos Maessen, Roberto Lorusso
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) application in post-cardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications. METHODS: A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed...
June 27, 2018: Annals of Thoracic Surgery
Prashant N Mohite, Anton Sabashnikov, Achim Koch, Raj Binu, Ashok Padukone, Sundip Kaul, Olaf Maunz, Diana García-Sáez, Bartlomiej Zych, Mubassher Husain, Fabio De Robertis, Aron-Frederik Popov, André R Simon
OBJECTIVES: Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support (MCS). The aim of the study was to compare extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) utilized in the management of PCCS. METHODS: In total, 56 consecutive patients who developed PCCS from 2005 to 2014 required MCS as a bridge to decision-24 were supported with a VAD and 32 with an ECMO...
December 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Ibrahim Sultan, Andreas Habertheuer, Tyler Wallen, Mary Siki, Wilson Szeto, Joseph E Bavaria, Matthew Williams, Prashanth Vallabhajosyula
BACKGROUND AND AIM: Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post-cardiotomy shock. We sought to determine the utility of ECMO implementation post-TAAD repair. METHODS: The Pennsylvania Health Care Cost Containment Council (PHC4) database, maintained by an independently functioning state agency, was retrospectively reviewed from 2004 to 2014...
December 2017: Journal of Cardiac Surgery
Peter Blom Jensen, Sigrun Høegholm Kann, Karsten Tange Veien, Ole Kristian Møller-Helgestad, Jordi Sanchez Dahl, Charlotte Svejstrup Rud, Marianne Kjær Jensen, Lisette Okkels Jensen, Henrik Schmidt, Jacob Eifer Møller
RATIONALE: Short-term mechanical circulatory support is increasingly used in the management of cardiogenic shock, but data from controlled studies are sparse. Thus, real-life data on complication rates and predictors of adverse outcome are important. OBJECTIVE: The objective of this study was to analyse the experience with Impella devices in the management of profound cardiogenic shock. METHODS AND RESULTS: A retrospective study of 109 consecutive patients with severe shock after myocardial infarction, acute heart failure, or cardiac surgery...
February 2018: European Heart Journal. Acute Cardiovascular Care
Sakir Akin, Dinis Dos Reis Miranda, Kadir Caliskan, Osama I Soliman, Goksel Guven, Ard Struijs, Robert J van Thiel, Lucia S Jewbali, Alexandre Lima, Diederik Gommers, Felix Zijlstra, Can Ince
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly adopted for the treatment of cardiogenic shock (CS). However, a marker of successful weaning remains largely unknown. Our hypothesis was that successful weaning is associated with sustained microcirculatory function during ECMO flow reduction. Therefore, we sought to test the usefulness of microcirculatory imaging in the same sublingual spot, using incident dark field (IDF) imaging in assessing successful weaning from VA-ECMO and compare IDF imaging with echocardiographic parameters...
October 26, 2017: Critical Care: the Official Journal of the Critical Care Forum
Julien Guihaire, Simon Dang Van, Simon Rouze, Sébastien Rosier, Antoine Roisne, Thierry Langanay, Hervé Corbineau, Jean-Philippe Verhoye, Erwan Flécher
OBJECTIVES: Post-cardiotomy cardiogenic shock is a major concern in cardiac surgery. We reviewed our experience of extracorporeal membrane oxygenation (ECMO) as temporary circulatory support in post-cardiotomy cardiogenic shock. METHODS: Between January 2005 and December 2014, adult patients implanted with ECMO after cardiac surgical procedures were included. Indications for ECMO were failure to be withdrawn from cardiopulmonary bypass or refractory cardiogenic shock occurring during postoperative Days 1 and 2...
September 1, 2017: Interactive Cardiovascular and Thoracic Surgery
Corstiaan A den Uil, Sakir Akin, Lucia S Jewbali, Dinis Dos Reis Miranda, Jasper J Brugts, Alina A Constantinescu, Arie Pieter Kappetein, Kadir Caliskan
Short-term mechanical circulatory support (MCS) is increasingly used as a bridge to decision in patients with refractory cardiogenic shock. Subsequently, these patients might be bridged to durable MCS either as a bridge to candidacy/transplantation, or as destination therapy. The aim of this study was to review support duration and clinical outcome of short-term MCS in cardiogenic shock, and to analyse application of this technology as a bridge to long-term cardiac support (left ventricular assist device, LVAD) from 2006 till June 2016...
July 1, 2017: European Journal of Cardio-thoracic Surgery
Corstiaan A den Uil, Lucia S Jewbali, Martijn J Heeren, Alina A Constantinescu, Nicolas M Van Mieghem, Dinis Dos Reis Miranda
AIMS: We investigated survival according to the nature of heart failure (isolated left, vs isolated right, vs biventricular heart failure) in patients undergoing extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock of different causes. METHODS AND RESULTS: This single-center study included 132 patients with acute myocardial infarction (20%), acute on chronic heart failure (14%), post cardiotomy (17%), cardiac allograft failure (8%), pulmonary embolism (16%), and acute nonischemic heart failure (25%)...
May 2017: European Journal of Heart Failure
Ryan Chiu, Eric Pillado, Sohail Sareh, Kim De La Cruz, Richard J Shemin, Peyman Benharash
BACKGROUND: Over the past decade, extracorporeal mechanical support (ECMO) has been increasingly utilized in respiratory failure and cardiogenic shock. There is a need for assessing clinical and financial outcomes of ECMO use. This study presents our institution's experience with veno-arterial ECMO (VA-ECMO) over a 9-year period. METHODS: A retrospective review of our institution's ECMO database identified patients undergoing VA-ECMO between 2005 and 2013 (N = 150)...
March 2017: Journal of Cardiac Surgery
Zhongtao Du, Zaishen Jia, Jinhong Wang, Zhichen Xing, Chunjing Jiang, Bo Xu, Xiaofang Yang, Feng Yang, Na Miao, Jialin Xing, Hong Wang, Ming Jia, Xiaotong Hou
BACKGROUND: Little is known about the effect of mean arterial blood pressure (MAP) augmentation on the microcirculation in cardiogenic-shock patients with peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) support. We investigated the effect of increasing MAP on the microcirculation in cardiogenic-shock patients with ECMO support. METHODS: A single-center prospective observational study under taken in ICU patients undergoing ECMO support for post-cardiotomy cardiogenic shock was carried out...
2018: Clinical Hemorheology and Microcirculation
Margaux Pontailler, Pierre Demondion, Guillaume Lebreton, Jean-Louis Golmard, Pascal Leprince
The two main objectives of this single-center, retrospective study were to analyze the outcomes and to identify the independent predictors of 30 day and long-term mortality in case of cardiopulmonary resuscitation requiring extracorporeal life support (ECLS) in the elderly patients. From October 2004 to May 2014, 163 patients with a mean age of 75.5 years (range 70-91) required veno-arterial ECLS. The main indication was postcardiotomy cardiogenic shock (79.6%). Extracorporeal life support duration averaged 5...
May 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Federico Pappalardo, Andrea Montisci
Post-cardiotomy cardiogenic shock (PCCS) is a complication of heart surgery associated with a poor prognosis: veno-arterial extracorporeal membrane oxygenation (VA ECMO) ensures end-organ perfusion while fully replacing heart and lung function, though it is associated with unsatisfactory results. Few studies have identified reliable predictors of poor prognosis early in the course of extracorporeal support. A recent study showed the strong prognostic power of urine output in the first 24 hours of VA ECMO in predicting early and late mortality of PCCS...
October 2016: Journal of Thoracic Disease
Nawar Al-Rawas, David Ranney, Lynn McGugan, Marat Fudim, Sade Bell, Annemarie Thompson, Desiree Bonadonna, Mani Daneshmand
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
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