Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?

Hoy, Fredrick B.Y; Mueller, Dale K.; Geiss, Dale M.; Munns, James R.; Bond, Linda M; Linett, Carol E; Gomez, Robert C

doi:10.1016/s0003-4975(00)01715-x

Cited by 41 publications

(19 citation statements)

References 14 publications

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“…The decisions surrounding when best to institute or withdraw such invasive and resource-intensive therapy remains controversial and there are no universally agreed upon guidelines on the indications for this therapy. VA ECMO in the context of refractory PCCS is mainly instituted as a temporizing measure as a “bridge to recovery” [5, 8, 9]. However, it has also been utilized as a “bridge to decision” and “destination therapy” with long-term implantable devices (e.g.…”

Section: Introductionmentioning

confidence: 99%

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Khorsandi

Dougherty

Bouamra

et al. 2017

J Cardiothorac Surg

165

120

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BackgroundPostcardiotomy cardiogenic shock (PCCS) refractory to inotropic support and intra-aortic balloon pump (IABP) occurs rarely but is almost universally fatal without mechanical circulatory support. In this systematic review and meta-analysis we looked at the evidence behind the use of veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in refractory PCCS from a patient survival rate and determinants of outcome viewpoint.MethodsA systematic review was performed in January 2017 using PubMed (with no defined time period) using the keywords “postcardiotomy”, “cardiogenic shock”, “extracorporeal membrane oxygenation” and “cardiac surgery”. We excluded papers pertaining to ECMO following paediatric cardiac surgery, medical causes of cardiogenic shock, as well as case reports, review articles, expert opinions, and letters to the editor. Once the studies were collated, a meta-analysis was performed on the proportion of survivors in those papers that met the inclusion criteria. Meta-regression was performed for the most commonly reported adverse prognostic indicators (API).ResultsWe identified 24 studies and a cumulative pool of 1926 patients from 1992 to 2016. We tabulated the demographic data, including the strengths and weaknesses for each of the studies, outcomes of VA ECMO for refractory PCCS, complications, and APIs. All the studies were retrospective cohort studies. Meta-analysis of the moderately heterogeneous data (95% CI 0.29 to 0.34, p < 0.01, I 2 = 60%) revealed overall survival rate to hospital discharge of 30.8%. Some of the commonly reported APIs were advanced age (>70 years, 95% CI −0.057 to 0.001, P = 0.058), and long ECMO support (95% CI −0.068 to 0.166, P = 0.412). Postoperative renal failure, high EuroSCORE (>20%), diabetes mellitus, obesity, rising lactate whilst on ECMO, gastrointestinal complications had also been reported.ConclusionHaemodynamic support with VA ECMO provides a survival benefit with reasonable intermediate and long-term outcomes. Many studies had reported advanced age, renal failure and prolonged VA ECMO support as the most likely APIs for VA ECMO in PCCS. EuroSCORE can be utilized to anticipate the need for prophylactic perioperative VA ECMO in the high-risk category. APIs can be used to aid decision-making regarding both the institution and weaning of ECMO for refractory PCCS.

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Section: Introductionmentioning

confidence: 99%

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Khorsandi

Dougherty

Bouamra

et al. 2017

J Cardiothorac Surg

165

120

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“…If a reversible myocardial injury occurs during a cardiac surgery, myocardial function can improve the myocardial work is reduced, the main goal of physiological circulatory assist devices [14]. The myocardial stunning is defined as a post-ischemic myocardial dysfunction prolonged, but transient, of a viable myocardium that was recovered by reperfusion, despite the cardioprotection afforded by administration of cold cardioplegia during aortic clamping, this dysfunction is a well recognized sequel of cardiopulmonary prolonged bypass [15].…”

Section: Discussionmentioning

confidence: 99%

Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

Júnior¹,

Tagliari²,

Luvizetto³

et al. 2012

Rev Bras Cir Cardiovasc

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Background:The low cardiac output syndrome in perioperative period of cardiac surgery may occur in about 10 to 15% of patients; of this total, 2% require mechanical support for adequate hemodynamic control.Objective: This study aimed to describe the mortality of patients requiring intra-aortic balloon pump (IABP) in transor post-cardiac surgery, identifying preoperative variables associated with a worse outcome, as well as describe the postoperative complications and survival in the medium term. Patients and Methods: retrospective cohort study including 80 consecutive cases between January/2009 and September/ 2011. The patients had on average 62.9 ± 11.3 years and 58.8% were male. In the sample, 81.3% were hypertensive, 50% had previous myocardial infarction and 38.8% heart failure NYHA III/IV. The most common surgery performed was isolated coronary artery bypass grafting (37.5%).Results: Hospital mortality was 53.8% (95% HF: 42.7-64.9) and the cross-clamp time >90 minutes was an independent predictor of mortality in multivariate analysis (RR 1.52 95% HF: 1.04-2.22). Regarding complications, 71.3% (95% HF: 61.2 to 81.4) of patients had at least one additional complication: the lower limb ischemia was observed in 5.0% of patients. The 1-year survival was 43.6%, observing a plateau in the survival rate after an initial sharp drop, related to hospital mortality.Conclusion: Patients who need the IABP form a group of very high risk for morbidity and mortality. Its use, however, allows many patients to recover an evolution that was invariably fatal, having the patients discharged home a good survival in the medium term.Descriptors: Intra-aortic balloon pumping. Cardiac surgical procedures. Cardiac output, low. ResumoFundamento: A síndrome de baixo débito cardíaco no perioperatório de cirurgia cardíaca pode incidir em cerca de 10 a 15% dos pacientes; desse total, 2% necessitam de suporte mecânico para adequado controle hemodinâmico.Objetivos: Descrever a mortalidade de pacientes que necessitaram utilizar balão intra-aórtico (BIAo) no trans ou pós-operatório de cirurgia cardíaca, identificando variáveis pré-operatórias associadas a pior desfecho, assim como descrever as complicações pós-operatórias e a sobrevida em médio prazo. Rev Bras Cir Cardiovasc 2012;27(2):251-9

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“…10,11,14 Like the PVAD, ECMO can be rapidly implemented during cardiac arrest and active resuscitation. In averaging the results from several other studies, however, we found that SRCS patients receiving ECMO support as a bridge to LVAD or OHT had a substantially greater mortality rate (50%) than the patients in our study (27%), even though ECMO recipients had a higher initial probability of survival before resuscitation (60% vs 20% according to the patients' RFSS scores).…”

Section: Discussionmentioning

confidence: 99%

Use of the Percutaneous Left Ventricular Assist Device in Patients with Severe Refractory Cardiogenic Shock as a Bridge to Long-term Left Ventricular Assist Device Implantation

Idelchik¹,

Simpson²,

Civitello³

et al. 2008

The Journal of Heart and Lung Transplantation

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Bridge to recovery for postcardiotomy failure: is there still a role for centrifugal pumps?

Cited by 41 publications

References 14 publications

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: a systematic review and meta-analysis

Use of intra-aortic balloon pump in cardiac surgery: analysis of 80 consecutive cases

Use of the Percutaneous Left Ventricular Assist Device in Patients with Severe Refractory Cardiogenic Shock as a Bridge to Long-term Left Ventricular Assist Device Implantation

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