Combined Impella and intra-aortic ballon pump support to improve macro- and microcirculation: a clinical case

Jung, Christian; Ferrari, Markus; Rödiger, Christoph; Fritzenwanger, Michael; Figulla, Hans‐Reiner

doi:10.1007/s00392-008-0693-2

Cited by 27 publications

(13 citation statements)

References 5 publications

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“…Sub-lingual perfused capillary density and cRBCv both increased in all patients, which resulted in a 3-fold increase in the tissue perfu- Several recent case reports have described a relatively preserved microvascular blood flow in single patients with cardiogenic shock being treated with an Impella device (Abiomed, Danvers, MA) 15 or ECMO. 16 We analyzed the microcirculation before and after MCS implantation, thus providing direct evidence for a beneficial effect of cardiac assist devices on tissue microcirculation.…”

Section: Discussionmentioning

confidence: 96%

Mechanical Circulatory Support Devices Improve Tissue Perfusion in Patients With End-Stage Heart Failure or Cardiogenic Shock

Uil

Maat

Lagrand

et al. 2009

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 96%

Mechanical Circulatory Support Devices Improve Tissue Perfusion in Patients With End-Stage Heart Failure or Cardiogenic Shock

Uil

Maat

Lagrand

et al. 2009

The Journal of Heart and Lung Transplantation

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“…Darüber hinaus wurde auch die Anwendung von mechanischen "assist devices" evaluiert [24,25]. Beispielsweise wurde gezeigt, dass sich durch die Stabilisierung des Kreislaufs mithilfe extrakorporaler Membranoxygenierung (ECMO) auch die Mikrozirkulation stabilisieren lässt [16,23]. Zurzeit werden Studien, die den genauen Stellenwert dieser Maßnahmen in diagnostischen und therapeutischen Algorithmen bestimmen, durchgeführt.…”

Section: Assessment Of Microcirculation In Critically Ill Patients Abunclassified

Beurteilung der Mikrozirkulation beim kritisch kranken Patienten

Jung

Kelm

Ferrari

2016

Med Klin Intensivmed Notfmed

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Adequate organ supply of oxygen and of nutrients depends on microcirculation. Impaired microcirculation may result in temporary or irreversible loss of function. Therefore, critically ill patients require early diagnosis and therapy of microcirculatory disorders. Besides surrogate parameters of microcirculation like urine production or serum lactate levels, direct visualization became possible with sidestream darkfield intravital microscopy. This technique has been evaluated in clinical studies focusing on early diagnosis and therapy in cardiogenic shock like vasopressors, nitrates, or circulatory assist devices. Further studies evaluating measurements of microcirculation are necessary before a general recommendation for its routine use can be made.

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“…However to date, little is known about the alterations in tissue perfusion and circulatory characteristics at the microvascular level, particularly in the acute phase of STEMI. Additionally, the effect of circulatory support on MC in STEMI patients after PCI has not been studied before [13][14][15][16]. Furthermore, the interference of the continuous flow of a circulatory support device with the normal vascular pulsatility is another unsolved issue.…”

Section: Introductionmentioning

confidence: 99%

Improved microcirculation in patients with an acute ST-elevation myocardial infarction treated with the Impella LP2.5 percutaneous left ventricular assist device

et al. 2009

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Background Circulatory support during percutaneous coronary intervention (PCI) in patients with ST-element elevation myocardial infarction (STEMI) aims at maintaining hemodynamic stability and organ perfusion. However, continuous flow pumps may interfere with the normal pulsatile circulation and the microcirculatory function. Sidestream dark field (SDF) imaging allows the visualization of microvascular structure and function of tissue and may provide information regarding the efficacy of the circulatory support. Methods Sidestream dark field was used to study the sublingual microcirculation (MC) in six anterior STEMI patients treated with PCI; three patients received Impella LP2.5 percutaneous left ventricular support (Impella group) and three patients received no support (control group). MC was assessed at baseline, at 24, 48 and 72 h after PCI. Data were analyzed using a validated scoring method and the microvascular flow index (MFI) and perfused vessel density (PVD) were calculated. MC of three healthy controls was used as normalized standard. Results Normal MC depending on both functional capillary density (PVD) and flow velocity or quality (MFI), as observed in healthy controls, was only achieved in the Impella group and paralleled improvement in LV function. Functional capillary density in the control and Impella groups were respectively equal and above the level of healthy controls. The quality of microcirculatory flow only in the Impella group reached values of healthy controls. Conclusions Microcirculation assessed by SDF improved in STEMI patients treated with the Impella LP2.5 to levels observed in healthy persons and remained suboptimal after 72 h in patients without support. Sublingual SDF to assess MC may serve as a monitor of effective myocardial recovery after PCI and optimization of organ perfusion.

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Combined Impella and intra-aortic ballon pump support to improve macro- and microcirculation: a clinical case

Cited by 27 publications

References 5 publications

Mechanical Circulatory Support Devices Improve Tissue Perfusion in Patients With End-Stage Heart Failure or Cardiogenic Shock

Mechanical Circulatory Support Devices Improve Tissue Perfusion in Patients With End-Stage Heart Failure or Cardiogenic Shock

Beurteilung der Mikrozirkulation beim kritisch kranken Patienten

Improved microcirculation in patients with an acute ST-elevation myocardial infarction treated with the Impella LP2.5 percutaneous left ventricular assist device

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