Concomitant use of VA-ECMO and Impella with inhaled nitric oxide to treat cardiogenic shock after cardiac surgery: A case report

Higashino, Akihiro; Yahagi, Kazuyuki; Taketani, Tsuyoshi; Miura, Sumio; Ohno, Takayuki

doi:10.1016/j.jccase.2022.07.003

Cited by 3 publications

(1 citation statement)

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“…There have been case reports highlighting a similar efficacy of iNO in ECPELLA for fulminant myocarditis and cardiogenic shock following cardiac surgery. 5 , 6 Our case presents a similar situation to these two case reports.…”

Section: Discussionsupporting

confidence: 81%

Haemodynamic effects of inhaled nitric oxide in acute myocardial infarction complicated by right heart failure under ECPELLA support: case report

Fujita,

Ueno,

Yasuda

et al. 2023

European Heart Journal - Case Reports

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Background Recently, mechanical support obtained with the combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella device, together referred to as ECPELLA, has been shown to be effective for acute myocardial infarction with cardiogenic shock. However, methods for withdrawing VA-ECMO in acute myocardial infarction cases complicated by right ventricular dysfunction are yet to be established. Here, we report the effective use of inhaled nitric oxide during the weaning of VA-ECMO from the ECPELLA management of a patient with acute myocardial infarction with cardiogenic shock. Case presentation An 81-year-old man with an acute extensive anterior wall myocardial infarction with cardiogenic shock was supported with ECPELLA to improve his hemodynamics. During ECPELLA, the Impella device could not maintain sufficient flow. Echocardiography revealed a small left ventricle and an enlarged right ventricle, indicating acute right heart failure. Inhaled nitric oxide was initiated to reduce right ventricle afterload, which decreased pulmonary artery pressure from 34/20 to 27/13 mmHg, improved right and left ventricle sizes, and stabilized the Impella support. Afterward, VA-ECMO could be withdrawn because the Impella alone was sufficient for hemodynamic support. Conclusions Inhaled nitric oxide improved right ventricle performance in a patient with severe myocardial infarction with right heart failure supported by ECPELLA. Thus, we suggest that inhaled nitric oxide facilitates the weaning of VA-ECMO from patients with refractory right ventricular dysfunction who are supported by ECPELLA.

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Section: Discussionsupporting

confidence: 81%