Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

Prisco, Anthony R.; Aguado-Sierra, Jazmín; Butakoff, Constantine; Vázquez, Mariano; Houzeaux, Guillaume; Eguzkitza, Beatriz; Bartos, Jason A.; Yannopoulos, Demetris; Raveendran, Ganesh; Holm, Mikayle A.; Iles, Tinen L.; Mahr, Claudius; Iaizzo, Paul A.

doi:10.1007/s12265-021-10110-2

Cited by 20 publications

(14 citation statements)

References 24 publications

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“…Given the native LV contractility, the deoxygenated blood is then ejected into the ascending aorta. As a result, a mixing cloud forms between the anterograde flowing deoxygenated blood and the fully oxygenated retrograde flow provided by the circuit ( 179 ) ( Figure 1 ). The location of the mixing cloud depends on the native cardiac function and the level of competing ECMO flow.…”

Section: Complications Of Va-ecmo Supportmentioning

confidence: 99%

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Tsangaris

Alexy

Kalra

et al. 2021

Front. Cardiovasc. Med.

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Cardiogenic shock accounts for ~100,000 annual hospital admissions in the United States. Despite improvements in medical management strategies, in-hospital mortality remains unacceptably high. Multiple mechanical circulatory support devices have been developed with the aim to provide hemodynamic support and to improve outcomes in this population. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is the most advanced temporary life support system that is unique in that it provides immediate and complete hemodynamic support as well as concomitant gas exchange. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO support in patients with cardiogenic shock of various etiologies. In addition, we review the common indications, contraindications and complications associated with VA-ECMO use.

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Section: Complications Of Va-ecmo Supportmentioning

confidence: 99%

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Tsangaris

Alexy

Kalra

et al. 2021

Front. Cardiovasc. Med.

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“…However, their neurological symptoms were relieved after improving upper body oxygenation. Previous studies have also suggested that in patients receiving femo-femoral VA ECMO with respiratory circulatory failure, myocardial hypoxia occurred as residual cardiac function increased (30). Coronary oxygen saturation was measured using proximal aortic oxygen saturation, and coronary oxygen insufficiency has been demonstrated in patients (9).…”

Section: Discussionmentioning

confidence: 99%

Drainage From Superior Vena Cava Improves Upper Body Oxygenation in Patients on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation

Cai

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTo investigate the feasibility of drainage from the superior vena cava (SVC) to improve upper body oxygenation in patients with cardiogenic shock undergoing femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO).MethodsSeventeen adult patients receiving peripheral femoral VA ECMO for circulatory support were enrolled. The femoral drainage cannula was shifted three times (from the inferior vena cava (IVC) level to the SVC level and then the IVC level again), all under ultrasound guidance, at an interval of 15 minutes. The blood gas levels of the right radial artery (RA) and SVC and cerebral oxygen saturation (ScO2) were measured and compared.ResultsFifteen patients (88.2%) were successfully weaned from ECMO, and 12 patients (70.6%) survived to discharge. The oxygen saturation (SO2) and oxygen partial pressure (PO2) of the RA (97.0 ± 3.5% to 98.3 ± 1.5%, P < 0.05, SO2; 127.4 ± 58.2 mmHg to 153.1 ± 67.8 mmHg, P < 0.05, PO2) and SVC (69.5 ± 9.0% to 75.7 ± 8.5%, P < 0.05, SO2; 38.5 ± 5.6 mmHg to 43.6 ± 6.4 mmHg, P < 0.05, PO2) were increased; ScO2 was also increased on both sides (left: 50.6 ± 8.6% to 55.0 ± 9.0%, P < 0.05; right: 48.7 ± 9.2% to 52.3 ± 9.8%, P < 0.05) when the femoral drainage cannula was shifted from the IVC level to the SVC level. When the femoral drainage cannula was shifted from SVC level to the IVC level again, the SO2 and PO2 of RA (98.3 ± 1.5% to 96.9 ± 3.2%, P <0.05, SO2; 153.1 ± 67.8 mmHg to 125.8 ± 63.3 mmHg, P <0.05, PO2) and SVC (75.7 ± 38.5% to 70.4 ± 7.6%, P <0.05, SO2; 43.6 ± 6.4 mmHg to 38.9 ± 4.5 mmHg, P <0.05, PO2) were decreased; ScO2 was also reduced on both sides (left: 55.0 ± 9.0% to 50.7 ± 8.2%, P < 0.05; right: 52.3 ± 9.8% to 48.7 ± 9.3%, P <0.05).ConclusionDrainage from the SVC by shifting the cannula upward could improve upper body oxygenation in patients with cardiogenic shock undergoing femoral VA ECMO. This cannulation strategy provides an alternative solution for differential hypoxia.

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“…Finally, the reliability of SrO 2 at anticipating risk of ischemic cerebral events remains controversial. It is important to note that most studies have focused on early identification of cerebral ischemia, however in differential hypoxemia, myocardial ischemia will occur sooner due to the nature of arterial anatomy (coronaries are proximal to carotid arteries) [14]. Monitoring trends in ECG, cardiac biomarkers, and echocardiography may assist in timely recognition of myocardial ischemia in mixed cardiorespiratory disease.…”

Section: Key Pointsmentioning

confidence: 99%

Monitoring during extracorporeal membrane oxygenation

Castro

Morris

Teijeiro-Paradis

et al. 2022

Current Opinion in Critical Care

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Purpose of reviewExtracorporeal membrane oxygenation (ECMO) offers advanced mechanical support to patients with severe acute respiratory and/or cardiac failure. Ensuring an adequate therapeutic approach as well as prevention of ECMO-associated complications, by means of timely liberation, forms an essential part of standard ECMO care and is only achievable through continuous monitoring and evaluation. This review focus on the cardiorespiratory monitoring tools that can be used to assess and titrate adequacy of ECMO therapy; as well as methods to assess readiness to wean and/or discontinue ECMO support. Recent findingsSurrogates of tissue perfusion and near infrared spectroscopy are not standards of care but may provide useful information in select patients. Echocardiography allows to determine cannulas position, evaluate cardiac structures, and function, and diagnose complications. Respiratory monitoring is mandatory to achieve lung protective ventilation and identify early lung recovery, surrogate measurements of respiratory effort and ECMO derived parameters are invaluable in optimally managing ECMO patients. SummaryNovel applications of existing monitoring modalities alongside evolving technological advances enable the advanced monitoring required for safe delivery of ECMO. Liberation trials are necessary to minimize time sensitive ECMO related complications; however, these have yet to be standardized.

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Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

Cited by 20 publications

References 24 publications

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

Drainage From Superior Vena Cava Improves Upper Body Oxygenation in Patients on Femoral Veno-Arterial Extracorporeal Membrane Oxygenation

Monitoring during extracorporeal membrane oxygenation

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