Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure

Dangers, Laurence; Bréchot, N; Schmidt, Matthieu; Lebreton, Guillaume; Hékimian, Guillaume; Nieszkowska, Ania; Besset, Sébastien; Trouillet, Jean‐Louis; Chastre, Jean; Leprince, Pascal; Combes, Alain; Luyt, Charles‐Édouard

doi:10.1097/ccm.0000000000002485

Cited by 74 publications

(51 citation statements)

References 21 publications

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“…Equally, arterial lactate will not be in influenced by arterial carbon dioxide pressure levels, whereas arterial pH will. Arterial lactate has in agreement with our study also been found to be an independent pre‐VA‐ECMO predictor of short and midterm survival in several other studies with selected or unselected patients’ populations . Our finding of an odds ratio of 1.15 per mmol/L implies that the mortality risk increases 10‐fold at a lactate level of 10 mmol/L.…”

Section: Discussionsupporting

confidence: 92%

“…Previous larger studies have presented a combination of nonsurgical and surgical patients including both predictors before and during VA‐ECMO , or have not reported rate of missing data or having substantially incomplete data . The largest and only single center study strictly addressing the impact of pre‐ECMO variables on outcome by Waha et.…”

Section: Discussionmentioning

confidence: 99%

“…Although RCS represents the majority of patients on VA‐ECMO , the majority of studies have focused on postcardiotomy patients . Remaining studies have evaluated nonsurgical subgroups or a combination of nonsurgical and surgical populations , which complicates interpretation as the two latter cohorts have different pathophysiological mechanisms. Independent pre‐VA‐ECMO outcome predictors in an unselected nonsurgical population with RCS have only scarcely been identified as studies have mainly included variables from both before and after initiation of VA‐ECMO in the analysis , or have not reported rates of missing data or having substantially incomplete data .…”

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confidence: 99%

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VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

et al. 2018

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Refractory cardiogenic shock (RCS) is associated with a high mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as acute cardiopulmonary support but selection of VA-ECMO candidates remains challenging. There are limited data on which pre-VA-ECMO variables that predict outcome. The aim of this study was to identify pre-VA-ECMO predictors of 90-day mortality. We retrospectively analyzed 76 consecutive patients (median age 52; interquartile range [IQR]: 37-60) supported with VA-ECMO due to RCS. The association between pre-implant variables and all-cause mortality at 90 days was analyzed with multivariable logistic regression. Main etiologies of RCS were acute myocardial infarction 51% and other AHF etiologies 49%. Cardiopulmonary resuscitation was performed in 54% of patients before initiation of VA-ECMO. Median duration of VA-ECMO was 5 days (IQR: 2-11). The 90-day overall mortality was 49% and in-hospital

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

et al. 2018

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“…The Extracorporeal Life Support Organization states that contraindications to V‐A ECMO include chronic organ dysfunction . Veno‐arterial ECMO is indicated for decompensated chronic heart failure patients, but their mortality is high . Few reports of V‐A ECMO for septic shock patients with chronic heart failure exist.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, pre‐existing chronic heart failure is not a contraindication for VA‐ECMO in septic cardiomyopathy patients. A pre‐ECMO SOFA score >11, idiopathic cardiomyopathy as the cause of pre‐existing chronic heart failure, cardiac disease duration >2 years pre‐ECMO, and pre‐ECMO blood lactate >4 mmol/L are independent predictors of 1‐year mortality in patients receiving V‐A ECMO for acute decompensated heart failure . Regarding septic cardiomyopathy in chronic heart failure, the SOFA score and blood lactate level might not be mortality predictors because both are affected by sepsis itself, in addition to cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Successful use of veno‐arterial extracorporeal membrane oxygenation for septic cardiomyopathy in a patient with pre‐existing chronic heart failure

Wada

Bunya

Kakizaki

et al. 2019

Acute Medicine & Surgery

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Background Indications for using veno‐arterial extracorporeal membrane oxygenation (V‐A ECMO) in sepsis cases remain unclear. Case Presentation A 66‐year‐old man with pre‐existing chronic heart failure developed severe pneumonia resulting in refractory septic shock. He was diagnosed with septic cardiomyopathy based on depressed left ventricular ejection fraction and a dilated left ventricle based on a transthoracic echocardiogram. We initiated V‐A ECMO on day 3 because the shock did not respond to conventional therapy. The patient's hemodynamics improved, and his infection was reduced. He recovered fully and was discharged on day 107 with his cardiac function restored to its baseline. Conclusion Septic cardiomyopathy is a form of reversible myocardial dysfunction. Veno‐arterial extracorporeal membrane oxygenation should be considered for septic cardiomyopathy with intractable circulatory failure. Pre‐existing chronic heart failure is not a contraindication for VA‐ECMO.

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Time‐sensitive approach in the management of acute heart failure

et al. 2020

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Acute heart failure (AHF) has become a global public health burden largely because of the associated high morbidity, mortality, and cost. The treatment options for AHF have remained relatively unchanged over the past decades. Historically, clinical congestion alone has been considered the main target for treatment of acute decompensation in patients with AHF; however, this is an oversimplification of the complex pathophysiology. Within the similar clinical presentation of congestion, significant differences in pathophysiological mechanisms exist between the fluid accumulation and redistribution. Tissue hypoperfusion is another vital characteristic of AHF and should be promptly treated with appropriate interventions. In addition, recent clinical trials of novel therapeutic strategies have shown that heart failure management is 'time sensitive' and suggested that treatment selection based on individual aetiologies, triggers, and risk factor profiles could lead to better outcomes. In this review, we aim to describe the specifics of the 'time-sensitive' approach by the clinical phenotypes, for example, pulmonary/systemic congestion and tissue hypoperfusion, wherein patients are classified based on pathophysiological conditions. This mechanistic classification, in parallel with the comprehensive risk assessment, has become a cornerstone in the management of patients with AHF and thus supports effective decision making by clinicians. We will also highlight how therapeutic modalities should be individualized according to each clinical phenotype.

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Extracorporeal Membrane Oxygenation for Acute Decompensated Heart Failure

Cited by 74 publications

References 21 publications

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

VA‐ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre‐Implant Outcome Predictors

Successful use of veno‐arterial extracorporeal membrane oxygenation for septic cardiomyopathy in a patient with pre‐existing chronic heart failure

Time‐sensitive approach in the management of acute heart failure

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