Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

Tschöpe, Carsten; Alogna, Alessio; Faragli, Alessandro; Klingel, Karin; Schmidt, Günther; Heilmann, Torsten; Bastos, Marcelo B; Spillmann, Frank

doi:10.3389/fcvm.2020.563448

Cited by 7 publications

(17 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The simultaneous use of LVAD with VA ECMO has also been endorsed by a newly published case supporting the concept of potential future applications of dual assist devices. The EC-iVAC (simultaneous use of ECMO and iVAC) and ECMELLA (ECMO and Impella) approaches may be considered as an option among patients in CS in urgent need of immediate LV support [21,22]. Moreover, a recently published international multicenter cohort study evaluated the clinical outcomes in patients with CS treated with VA ECMO with or without LV unloading with the use of Impella showed that the mechanical LV support was associated with lower mortality [49].…”

Section: Discussionmentioning

confidence: 99%

“…Towards this direction, similarly demanding cases consist of patients in ECMO with shock, pulmonary edema and LV failure who need LV decompression. In order to reduce the effect of the watershed form, avoid coronary and cerebral hypoperfusion and increase cardiac output, a combination of ECMO and iVAC2L might be very profitable [21,22].…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

“…Through a systematic search of the existing literature, several studies and case reports implying the iVAC device support were identified (Table 2) [12,21,22,[43][44][45][46][47][48], while indications of use, type of vascular access, pre-and post-implantation hemodynamical parameters, as well as potential complications of the implanta- idence, provide guidance on device selection and way of implantation, depending on the hemodynamic status and individual history of each patient.…”

Section: Ivac2lmentioning

confidence: 99%

“…Hemolysis has also been linked with worse prognosis in patients with acute coronary syndrome [61][62][63]. Tschope, et al reported a case of significant hemolysis after the simultaneous use of VA ECMO and Impella devices, while the substitution of Impella with iVAC supported the hemodynamic status of the patient efficiently and resulted in a slighter hemolytic effect [22]. Furthermore, additional disadvantages of the percutaneous assist devices are the controversial selection of the most appropriate site for vascular catheter insertion, as well as the complications during the process or after the removal of the sheath.…”

Section: Complications Of Use and Removal Of The Devicementioning

confidence: 99%

See 3 more Smart Citations

Left Ventricular Assist Devices and Their Role in Cardiogenic Shock: Literature Review and Contemporary Data

Tzikas¹,

Ap²,

Boulmpou³

et al. 2021

Int J Clin Cardiol

View full text Add to dashboard Cite

Despite tremendous progress in the therapeutic algorithms of hemodynamically unstable patients, cardiogenic shock remains a clinical challenge with high mortality rate. Conservative management with inotropic agents remains the first-choice treatment, though it has been associated with serious adverse events and is not always adequate. Circulatory support with mechanical devices has been widely implemented in patients with cardiogenic shock during high-risk percutaneous coronary interventions or post-cardiac surgery complications and has been associated with favorable outcomes. In patients with acute decompensated heart failure, ventricular assist devices have been used to prolong the recovery period and reverse the cause of hemodynamic instability. In the present review, we discuss the current evidence on the use of percutaneous assist devices for the treatment of cardiogenic shock, plus we highlight the need for future evolution in this particular field that may permit the optimal choice of each device for different patients or clinical situations.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Section: Ivac2lmentioning

confidence: 99%

Section: Complications Of Use and Removal Of The Devicementioning

confidence: 99%

See 2 more Smart Citations

Left Ventricular Assist Devices and Their Role in Cardiogenic Shock: Literature Review and Contemporary Data

Tzikas¹,

Ap²,

Boulmpou³

et al. 2021

Int J Clin Cardiol

View full text Add to dashboard Cite

show abstract

“…Until a reliable strategy to unload or decompress the compromised and distended LV can be established, myocardial recovery will therefore continue to be impaired (10). In line with this, several modalities of temporarily mechanical ventricular support (MVS) for LV unloading as well as LV decompression under ECLS were investigated, such as atrial septostomy (11), the intra-aortic balloon pump (IABP) (12), the percutaneous transaortic pulsatile assist device iVAC2 R (13,14), the percutaneous continuous centrifugal pump TandemHeart R (6,15), as well as the Impella family of devices (2.5, CP, 5.0 and 5.5, Abiomed, Danvers, Massachusetts) (16). They differ with regard to the amount of liters pumped per minute (IABP 0.5, iVAC2L, Impella 2.5 up to 5.5 l/min, TandemHeart up to 5 l/min) as well as for their mode of action (pulsatile vs. nonpulsatile).…”

Section: Introductionmentioning

confidence: 99%

The “TIDE”-Algorithm for the Weaning of Patients With Cardiogenic Shock and Temporarily Mechanical Left Ventricular Support With Impella Devices. A Cardiovascular Physiology-Based Approach

Tschöpe

Spillmann

Potapov

et al. 2021

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Objectives: Mechanical circulatory support (MCS) is often required to stabilize therapy-refractory cardiogenic shock patients. Left ventricular (LV) unloading by mechanical ventricular support (MVS) via percutaneous devices, such as with Impella® axial pumps, alone or in combination with extracorporeal life support (ECLS, ECMELLA approach), has emerged as a potential clinical breakthrough in the field. While the weaning from MCS is essentially based on the evaluation of circulatory stability of patients, weaning from MVS holds a higher complexity, being dependent on bi-ventricular function and its adaption to load. As a result of this, weaning from MVS is mostly performed in the absence of established algorithms. MVS via Impella is applied in several cardiogenic shock etiologies, such as acute myocardial infarction (support over days) or acute fulminant myocarditis (prolonged support over weeks, PROPELLA). The time point of weaning from Impella in these cohorts of patients remains unclear. We here propose a novel cardiovascular physiology-based weaning algorithm for MVS.Methods: The proposed algorithm is based on the experience gathered at our center undergoing an Impella weaning between 2017 and 2020. Before undertaking a weaning process, patients must had been ECMO-free, afebrile, and euvolemic, with hemodynamic stability guaranteed in the absence of any inotropic support. The algorithm consists of 4 steps according to the acronym TIDE: (i) Transthoracic echocardiography under full Impella-unloading; (ii) Impella rate reduction in single 8–24 h-steps according to patients hemodynamics (blood pressure, heart rate, and ScVO2), including a daily echocardiographic assessment at minimal flow (P2); (iii) Dobutamine stress-echocardiography; (iv) Right heart catheterization at rest and during Exercise-testing via handgrip. We here present clinical and hemodynamic data (including LV conductance data) from paradigmatic weaning protocols of awake patients admitted to our intensive care unit with cardiogenic shock. We discuss the clinical consequences of the TIDE algorithm, leading to either a bridge-to-recovery, or to a bridge-to-permanent LV assist device (LVAD) and/or transplantation. With this protocol we were able to wean 74.2% of the investigated patients successfully. 25.8% showed a permanent weaning failure and became LVAD candidates.Conclusions: The proposed novel cardiovascular physiology-based weaning algorithm is based on the characterization of the extent and sustainment of LV unloading reached during hospitalization in patients with cardiogenic shock undergoing MVS with Impella in our center. Prospective studies are needed to validate the algorithm.

show abstract

Venting during venoarterial extracorporeal membrane oxygenation

et al. 2022

View full text Add to dashboard Cite

Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics—possibly with concomitant pulmonary congestion and even lung failure—and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option. Graphical abstract

show abstract

Case Report First-in-Man Method Description: Left Ventricular Unloading With iVAC2L During Veno-Arterial Extracorporeal Membrane Oxygenation: From Veno-Arterial Extracorporeal Membrane Oxygenation to ECMELLA to EC-iVAC®

Cited by 7 publications

References 14 publications

Left Ventricular Assist Devices and Their Role in Cardiogenic Shock: Literature Review and Contemporary Data

Left Ventricular Assist Devices and Their Role in Cardiogenic Shock: Literature Review and Contemporary Data

The “TIDE”-Algorithm for the Weaning of Patients With Cardiogenic Shock and Temporarily Mechanical Left Ventricular Support With Impella Devices. A Cardiovascular Physiology-Based Approach

Venting during venoarterial extracorporeal membrane oxygenation

Contact Info

Product

Resources

About