Intra-Aortic Balloon Pump Effects on Macrocirculation and Microcirculation in Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation*

Petroni, Thibaut; Harrois, Anatole; Amour, Julien; Lebreton, Guillaume; Bréchot, Nicolas; Tanaka, Sébastien; Luyt, Charles‐Édouard; Trouillet, Jean‐Louis; Chastre, Jean; Leprince, Pascal; Duranteau, Jacques

doi:10.1097/ccm.0000000000000410

Cited by 153 publications

(98 citation statements)

References 37 publications

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“…The same applies for overcoming LV distension during cardiac assistance, by switching from peripheral to central cannulation, or application of LV venting through different configurations as observed in our and other's experiences [10,12]. This variability reflects the lack of agreement or the ongoing debate about these peculiar aspects in VA-ECMO [25,26] and underlines that further investigations in this respect would be highly advisable.…”

Section: Commentmentioning

confidence: 60%

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Lorusso

Centofanti

Gelsomino

et al. 2016

The Annals of Thoracic Surgery

151

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Acute fulminant myocarditis (AFM) may represent a life-threatening event, characterized by rapidly progressive cardiac compromise that ultimately leads to refractory cardiogenic shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiocirculatory support in this circumstance, but few clinical series are available about early and long-term results. Data from a multicenter study group are reported which analyzed subjects affected by AFM and treated with VA-ECMO during a 5-year period

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Section: Commentmentioning

confidence: 60%

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Lorusso

Centofanti

Gelsomino

et al. 2016

The Annals of Thoracic Surgery

151

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“…The use of intra-aortic balloon pump with VA ECMO was underused as the combination has a favorable effect on LV dimension and decreases pulmonary artery pressure. 4 Limb ischemia (14% in this study) developed despite continuous bedside surveillance by Doppler. Again Doppler evaluation is episodic and does not adequately monitor limb perfusion particularly if patients have high pressor requirements.…”

mentioning

confidence: 88%

Acute Circulatory Support with ECMO

Moazami

Anandamurthy

2015

ASAIO Journal

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Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in the past few decades has become the mainstay of circulatory support for the treatment of refractory cardiogenic shock. There has been a resurgence of interest in ECMO with exponential increase in its use in adult population. 1 Technological improvements in cannulae, membrane oxygenators, pumps, circuits, portability, and ease of deployment have undoubtedly contributed to these trends. This has made possible the movement of ECMO out of the operating rooms and intensive care units into cardiac catheterization laboratories where interventional cardiologists are becoming more comfortable in initiating ECMO support for medically unmanageable cardiogenic shock complicated by acute myocardial infarction (AMI).In the manuscript by Truby et al., 2 the authors present contemporary results of VA ECMO in 179 patients at their center supported between 2007 and 2013. Overall results in this contemporary cohort closely reflects our experience with this technology. In a diverse patient population consisting primarily of postcardiotomy shock, AMI, primary graft failure after heart transplantation, and acute decompensated heart failure, they have achieved a respectable survival to hospital discharge close to 40%. The survival data are impressive when one considers that 30% of patients were undergoing active cardiopulmonary resuscitation (CPR) at the time of initiation of treatment. This puts into perspective that without ECMO, mortality was almost certain in all these patients. More importantly the mean duration of support in survivors was 3.6 days, and close to 30% were transitioned to other shortterm device (CentriMag, Thoratec Corp., Pleasanton, CA; n = 40) or durable left ventricular assist device (LVAD; n = 10). Expeditious restoration of circulatory and pulmonary support offers the greatest advantage of ECMO and "buys" time to sort out other issues including metabolic derangements, potential for recovery, eligibility for advanced therapies such as LVAD, or decision to withdraw support because of futility of further care. 3 The early determination of the prognosis of patients and the strategy to bridge select patients from ECMO to another device should be commended given the limitations and complications associated with prolonged ECMO support.Peripheral support applies constant afterload on the failing heart. In this report, 8.9% of patients developed left ventricle (LV) distention, which is likely an underestimate. Monitoring of LV distention by echocardiography is not always feasible at all times unless continuous imaging is available. Even if available, the LV geometry may not necessarily correlate with left ventricular enddiastolic pressure (LVEDP), and pulmonary complications may evolve before being clinically detectable. The use of intra-aortic balloon pump with VA ECMO was underused as the combination has a favorable effect on LV dimension and decreases pulmonary artery pressure. 4 Limb ischemia (14% in this study) developed despite continuous bedside sur...

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“…2,3 However, the use of IABP for acute LV decompression has not previously been studied. We examined the acute additive effect of IABP while treating a patient on extracorporeal membrane oxygenation who developed LV overdistention and diffuse ST-segment-elevation myocardial injury.…”

Section: To the Editormentioning

confidence: 99%

Letter by Reddy and Leesar Regarding Article “Assisted Beating of the Ischemic Heart: How to Manage the Pulseless ST-Segment–Elevation Myocardial Infarction Patient”

Reddy

Leesar

2015

Circulation

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We read with great interest the comprehensive article on the management of the pulseless ST-segment-elevation myocardial infarction patient by Lotz et al. 1 The authors correctly note that emergency insertion of existing left ventricular (LV) decompression devices into a coding patient supported by venoarterial extracorporeal membrane oxygenation is unlikely to be successful. Existing percutaneous decompression methods such as atrial transseptal cannulation or microaxial pump placement cannot be performed outside the catheterization laboratory and carry an extremely high risk of complications such as vascular injury, cardiac perforation, and pericardial tamponade when performed emergently. This is especially true for a coding patient who is undergoing chest compressions.Animal models and human studies of intra-aortic balloon counterpulsation (IABP) during extracorporeal membrane oxygenation have shown beneficial hemodynamic effects during chronic concurrent use.2,3 However, the use of IABP for acute LV decompression has not previously been studied. We examined the acute additive effect of IABP while treating a patient on extracorporeal membrane oxygenation who developed LV overdistention and diffuse ST-segment-elevation myocardial injury. Ten minutes after insertion of the IABP, the aortic pressure waveform showed marked improvement in pulsatility, echocardiography showed excellent aortic valve opening, and the LV end-diastolic pressure had decreased from 44 to 28 mm Hg, confirming rapid and effective acute LV decompression.Given that the IABP can be rapidly inserted at the bedside even in coding patients and has a lower risk of complications than existing methods of LV decompression during extracorporeal membrane oxygenation, we recommend its use in cases such as that described by Lotz et al in their article. DisclosuresNone. Gautam

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Intra-Aortic Balloon Pump Effects on Macrocirculation and Microcirculation in Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation*

Cited by 153 publications

References 37 publications

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Venoarterial Extracorporeal Membrane Oxygenation for Acute Fulminant Myocarditis in Adult Patients: A 5-Year Multi-Institutional Experience

Acute Circulatory Support with ECMO

Letter by Reddy and Leesar Regarding Article “Assisted Beating of the Ischemic Heart: How to Manage the Pulseless ST-Segment–Elevation Myocardial Infarction Patient”

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