Echocardiography in extracorporeal life support: A key player in procedural guidance, tailoring and monitoring

Donker, Dirk W.; Meuwese, Christiaan L.; Braithwaite, Sue; Broomé, Michael; Heijden, Joris J. van der; Hermens, Jeannine A.J.M.; Platenkamp, M.; Jong, Mark de; Janssen, J. G. D.; Borggrefe, Martin; Bělohlávek, Jan

doi:10.1177/0267659118766438

Cited by 43 publications

(40 citation statements)

References 66 publications

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“…In cardiogenic shock (CS) patients assisted by VA ECMO, echographic cardiac assessment is of paramount importance to set the degree of extracorporeal blood flow and concomitant supports such as mechanical ventilation, fluid loading and inotropic therapy (13,15,23,24).…”

Section: Echo Parametersmentioning

confidence: 99%

“…As comprehensive and dynamic echocardiographic measurements are mandatory to manage patients with CS patients assisted by ECMO, it seemed logical to assess the ability of echo parameters to predict successful weaning (23,24). Thus, we assessed the ability of echocardiographic variables to predict successful weaning in 51 patients receiving VA ECMO (13).…”

Section: Echo Parametersmentioning

confidence: 99%

See 1 more Smart Citation

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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Refractory cardiogenic shock patients may be rescued by veno-arterial extracorporeal membrane oxygenation (VA ECMO). After a few days of mechanical assistance, the device can sometimes be successfully removed if the patient has partially or fully recovered from the condition that required the use of ECMO. The percentage of patients with refractory cardiogenic shock who are successfully weaned from ECMO varies from 31% to 76%. Weaning does not mean survival, because 20% to 65% of patients weaned from VA ECMO support do not survive to hospital discharge. The high death rate after successful weaning shows that many questions remain unresolved in this field. In this review, we will discuss the various factors influencing survival and a successful weaning from VA ECMO, in addition to weaning approaches proposed in the literature. Based on this information, we will propose a strategy to optimize the weaning process.

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Section: Echo Parametersmentioning

confidence: 99%

Section: Echo Parametersmentioning

confidence: 99%

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ortuno¹,

Delmas²,

Diehl³

et al. 2019

Ann. Cardiothorac. Surg

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show abstract

“…We provide a schematic view of the Flow-chart for ECMO management form step 1 to step 4 and complete weaning (Figure 2). Hypotension, a rising CVP, atrial fibrillation, and a poorly contractile myocardium on echocardiography suggest weak recovery and a high risk of need of support [40,41]. Recently, the group of Esposito…”

Section: Destination Of Va-ecmomentioning

confidence: 99%

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

Amarelli¹,

Musumeci²,

Loforte³

et al. 2019

Advances in Extra-Corporeal Perfusion Therapies

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Cardiogenic shock (CS) still carries an unacceptably high mortality (30-60%), despite several therapeutic approaches; the SHOCK II trial questioned the benefit of intra-aortic balloon pump (IABP), while IMPRESS and CULPRIT-SHOCK trials confirmed heterogeneity in disease spectrum and patient selection for acute myocardial infarction-related CS requiring acute mechanical circulatory support (AMCS). The heterogeneity of devices employed as AMCS, including temporary micro-axial flow pumps (Impella), percutaneous bypass (TandemHeart), and extracorporeal life support (VA-ECMO), contributed to the actual dramatic scenario, where CS is defined clinically rather than hemodynamically. To date, the role of VA-ECMO is emerging as rapid strategy to mitigate mortality rates of severe refractory states, despite the lack of data regarding the best practices of management and flows control. VA-ECMO's flow represents the "dose" of treatment and higher flows are less tolerated percutaneously requiring, to prevent deleterious pulmonary edema and ventricular distention, additional approaches such as pulmonary, left atrial, or left ventricular unloading. Any efforts have to be directed to (1) determine adequate management of patients on VA-ECMO, (2) define the safer duration of VA-ECMO support, and (3) establish algorithms and techniques to predict and obtain stable weaning from ECMO or ensure fast transition to durable VAD and/or heart transplant.

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“…Echocardiography (ECHO) plays a pivotal role in the management of critical patients, particularly those supported with ECMO [9][10][11]. ECHO can be used to not only evaluate function and diagnose diseases requiring ECMO but also to detect all cardiac complications or vascular diseases that may arise following ECMO [12,13].…”

Section: General Role Of Echocardiographymentioning

confidence: 99%

Echocardiography Evaluation in ECMO Patients

Tritapepe¹,

Greco²,

Gaudio³

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Extracorporeal membrane oxygenation (ECMO) is a special form of organ support for selected cases of cardiovascular and severe respiratory failure. Echocardiography is a diagnostic and monitoring tool widely used in all aspects of ECMO support. The pathophysiology of ECMO, and its distinct effects on cardiorespiratory physiology, requires an echocardiographer with high skills to understand the interaction between the ECMO and the patient. In this chapter, we present the main application of echocardiography in ECMO patients and some general concepts on the ECMO working. ECMO, such as the standard cardiopulmonary bypass employed in cardiac surgery, V-V (veno-venous), can support the insufficient respiratory system by oxygenating and removing carbon dioxide from the blood. VA-ECMO (venous-arterial) can support haemodynamics by providing mechanical circulatory assistance. Today, ECMO can be used as bridge to decision, waiting for the development of the clinical conditions to support with other devices the evolution of cardiorespiratory failure or stop the assistance. Echocardiography (transthoracic (TTE) or transoesophageal (TOE)) can be used primarily to take decisions regarding appropriateness of ECMO support, therefore to control cannula insertion and confirm final position, to modify number and position of the cannulae in case of malfunctioning of these, and, finally, to assess clinical progress and suitability for weaning from ECMO.

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Echocardiography in extracorporeal life support: A key player in procedural guidance, tailoring and monitoring

Cited by 43 publications

References 66 publications

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Flow Optimization, Management, and Prevention of LV Distention during VA-ECMO

Echocardiography Evaluation in ECMO Patients

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