JCS/JSCVS/JCC/CVIT 2023 Guideline Focused Update on Indication and Operation of PCPS/ECMO/IMPELLA

Nishimura, Takashi; Hirata, Yasutaka; Ise, Takayuki; Iwano, Hiroyuki; Izutani, Hironori; Kinugawa, Koichiro; Kitai, Takeshi; Ohno, Takayuki; Ohtani, Tomohito; Okumura, Takahiro; Ono, Minoru; Satomi, Kazuhiro; Shiose, Akira; Toda, Koichi; Tsukamoto, Yasumasa; Yamaguchi, Osamu; Fujino, Takeo; Hashimoto, Toru; Higashi, Haruhiko; Higashino, Akihiro; Kondo, Toru; Kurobe, Hirotsugu; Miyoshi, Toru; Nakamoto, Kei; Nakamura, Makiko; Saito, Tetsuya; Saku, Keita; Shimada, Shogo; Sonoda, Hiromichi; Unai, Shinya; Ushijima, Tomoki; Watanabe, Takuya; Yahagi, Kazuyuki; Fukushima, Norihide; Inomata, Takayuki; Kyo, Shunei; Minamino, Tohru; Minatoya, Kenji; Sakata, Yasushi; Sawa, Yoshiki; ,

doi:10.1253/circj.cj-23-0698

Cited by 9 publications

(2 citation statements)

References 216 publications

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“…In humans, the goal should be ≥400–480 s during artificial heart‐lung management, ≥250 s during percutaneous coronary intervention, and 180–200 s for percutaneous cardiopulmonary support and intra‐aortic balloon pumping. 26 , 27 , 28 Thus, 220 s is not too high and is considered reasonable from an animal safety perspective.…”

Section: Discussionmentioning

confidence: 99%

Establishment of a swine model of delayed bleeding after endoscopic procedure

Uehara,

Sasaki,

Sahara

et al. 2024

DEN Open

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ObjectivesAlthough delayed bleeding after endoscopic procedures has become a problem, currently, there are no appropriate animal models to validate methods for preventing it. This study aimed to establish an animal model of delayed bleeding after endoscopic procedures of the gastrointestinal tract.MethodsActivated coagulation time (ACT) was measured using blood samples drawn from a catheter inserted into the external jugular vein of swine (n = 7; age, 6 months; mean weight, 13.8 kg) under general anesthesia using the cut‐down method. An upper gastrointestinal endoscope was inserted orally, and 12 mucosal defects were created in the stomach by endoscopic mucosal resection using a ligating device. Hemostasis was confirmed at this time point. The heparin group (n = 4) received 50 units/kg of unfractionated heparin via a catheter; after confirming that the ACT was ≥200 s 10 min later, continuous heparin administration (50 units/kg/h) was started. After 24 h, an endoscope was inserted under general anesthesia to evaluate the blood volume in the stomach and the degree of blood adherence at the site of the mucosal defect.ResultsDelayed bleeding was observed in three swine (75%) in the heparin‐treated group, who had a maximum ACT of >220 s before the start of continuous heparin administration. In the non‐treated group (n = 3), no prolonged ACT or delayed bleeding was observed at 24 h.ConclusionAn animal model of delayed bleeding after an endoscopic procedure in the gastrointestinal tract was established using a single dose of heparin and continuous heparin administration after confirming an ACT of 220 s.

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Section: Discussionmentioning

confidence: 99%

Establishment of a swine model of delayed bleeding after endoscopic procedure

Uehara,

Sasaki,

Sahara

et al. 2024

DEN Open

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“…COVID-19 not only causes pneumonia but also various cardiovascular diseases, especially myocarditis, which carries a risk of becoming severe [1]. In Japan, the combination of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and Impella, called "ECPELLA," is proposed in the guidelines for managing biventricular failure due to fulminant myocarditis [2]. However, there are few established reports on its management method.…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Ultrasound (POCUS)-Guided Management of Cardiogenic Shock in COVID-19 Fulminant Myocarditis With Combined Veno-Arterial Extracorporeal Membrane Oxygenation and Impella (ECPELLA): A Case Report

Kato,

Kurosaka,

Nakata

2024

Cureus

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The COVID-19 pandemic, which has been raging globally, has been reported to cause not only pneumonia but also various cardiovascular diseases. In particular, myocarditis poses a serious risk if it becomes severe. As a characteristic of myocardial damage in this disease, right ventricular dysfunction is frequently reported, and biventricular failure is not uncommon. In cases where cardiogenic shock occurs, ECPELLA, which combines veno-arterial extracorporeal membrane oxygenation and Impella, is used for management. Currently, in Japan, ECPELLA is the central treatment for severe biventricular failure in the acute phase. However, its management method has not been established. Weaning from ECPELLA requires the following three conditions: (1) improvement of left ventricular function; (2) improvement of right ventricular function; and (3) optimization of circulating plasma volume. However, since these conditions change moment by moment, frequent and detailed assessments are necessary. Nevertheless, considering the need for isolation due to COVID-19, there are limitations on the tests that can be performed. In this regard, point-of-care ultrasound (POCUS) allows repeated bedside evaluations while maintaining infection protection. We report that in the case of severe COVID-19-related myocarditis, the use of POCUS enabled the preservation of cardiac function and appropriate timing for weaning from ECPELLA.

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