Concomitant use of veno-arterial extracorporeal membrane oxygenation and Impella in the intensive care unit: a case report of fulminant myocarditis with multi-organ failure

Abstract

We would like to present a case of a young male patient with fulminant myocarditis and multi-organ failure treated in our intensive care unit. In the early phase of the treatment, we simultaneously applied mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (ECMO). The use of short-term MCS devices in fulminant myocarditis and in other forms of severe heart failure has increased in recent years [1]. The results of some clinical trials indicate that this mode of treatment, when applied in the early phase of cardiogenic shock, yields promising final results [2,3].A 27-year old, previously healthy man was admitted to the Emergency Department with dyspnea, chest pain, and arterial hypotension. He had been suffering from flu-like syndrome for a week prior to admission. Upon hospital arrival, his mean arterial pressure was 50 mm Hg, and the heart rate was 120 beats per minute. Transthoracic echocardiogram (TTE) revealed severe dysfunction of both ventricles with 15% left ventricular (LV) ejection fraction (EF), 8 cm s -1 velocity-time integral of the left ventricle outflow track (LVOT VTI), and 12 mm tricuspid annular plane systolic excursion (TAPSE). Laboratory tests showed troponin above

Fulminant myocarditis and acute heart failure in the light of new American Heart Association 2020 guidelines. Mechanical cardiac support and endomyocardial biopsy. What should be first?

“…In the presented history, the IABP used in the first hours was ineffective and the patient required VA-ECMO [ 5 ]. The data indicate that the most commonly used MCS for fulminant myocarditis is VA-ECMO, which draws blood from the right atrium and pumps it into the aorta.…”

Fully percutaneous insertion and removal of the Impella CP via a subclavian approach

“…The Impella (Abiomed) is a mechanical circulatory support device which augments cardiac output, but may also unload a left ventricle during venoarterial extracorporeal membrane oxygenation (ECMO) [1]. However, the Impella requires an access to a large artery and this may be problematic in a severe peripheral arterial disease.…”