Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices

Chieffo, Alaide; Dudek, Dariusz; Hassager, Christian; Gramegna, Mario; Halvorsen, Sigrun; Huber, Kurt; Kunadian, Vijay; Malý, Jiří; Møller, Jacob Eifer; Pappalardo, Federico; Tarantini, Giuseppe; Tavazzi, Guido; Thiele, Holger; Vandenbriele, Christophe; Mieghem, Nicolas Van; Vranckx, Pascal; Werner, Nikos; Price, Susanna

doi:10.1093/ehjacc/zuab015

Cited by 56 publications

(61 citation statements)

References 118 publications

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“…Management must respect all the principles of critical care, including care bundles and multidisciplinary team (MDT) practice, while aiming to resolve CS and avoiding complications. [4][5][6] At the point of referral or when CS is recognized, an emergency shock MDT should be convened to define the treatment pathway within the chain of survival in CS (Figure 1). 7 This includes rapidly determining and executing the critical care and MCS strategy and/or transferring to a CS center for ongoing management.…”

Section: General Principlesmentioning

confidence: 99%

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Intensive Care Management of the Cardiogenic Shock Patient

Uddin

Anandanadesan

Trimlett

et al. 2022

US Cardiology Review

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Optimal management of patients with cardiogenic shock requires a detailed and systematic assessment of all organ systems, balancing the risks and benefits of any investigation and intervention, while avoiding the complications of critical illness. Overall prognosis depends upon a number of factors, including that of the underlying cardiac disease and its potential reversibility, the severity of shock, the involvement of other organ systems, the age of the patient and comorbidities. As with all intensive care patients, the mainstay of management is supportive, up to and including implementation and management of a number of devices, including acute mechanical circulatory support. The assessment and management of these most critically ill patients therefore demands in-depth knowledge and skill relating to cardiac intensive care, extending well beyond standard intensive care or cardiology practice.

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Section: General Principlesmentioning

confidence: 99%

“…[3][4][5][8][9][10] Studies have demonstrated that a standardized team-based approach in highvolume centers, using care protocols with early MCS coupled with close monitoring (invasive hemodynamics, biomarkers and echocardiography) has the potential to improve outcomes. [3][4][5][6][7][8][9][10]…”

Section: Acute Mechanical Circulatory Supportmentioning

confidence: 99%

Intensive Care Management of the Cardiogenic Shock Patient

Uddin

Anandanadesan

Trimlett

et al. 2022

US Cardiology Review

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“…Data from clinical studies evaluating use of ECMO in the setting of OHCA are limited and they report low survival rates and disappointing neurologic outcomes [36,37]. However, ECMO is still useful in situations requiring high flow support and optimal oxygenation [15,38]. Schmidt et al suggested 10 situations in which use of ECMO is often futile and included a case series of critically ill patients with long low-flow periods, lasting more than 30 min and more [39].…”

Section: Effectiveness Of Prompt Cardiac Assistancementioning

confidence: 99%

Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

Manzo

Nix

Goetzenich

et al. 2021

JCM

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Introduction: Despite the improvements in standardized cardiopulmonary resuscitation, survival remains low, mainly due to initial myocardial dysfunction and hemodynamic instability. Our goal was to compare the efficacy of two left ventricular assist devices on resuscitation and hemodynamic supply in a porcine model of ventricular fibrillation (VF) cardiac arrest. Methods: Seventeen anaesthetized pigs had 12 min of untreated VF followed by 6 min of chest compression and boluses of epinephrine. Next, a first defibrillation was attempted and pigs were randomized to any of the three groups: control (n = 5), implantation of an percutaneous left ventricular assist device (Impella, n = 5) or extracorporeal membrane oxygenation (ECMO, n = 7). Hemodynamic and myocardial functions were evaluated invasively at baseline, at return of spontaneous circulation (ROSC), after 10–30–60–120–240 min post-resuscitation. The primary endpoint was the rate of ROSC. Results: Only one of 5 pigs in the control group, 5 of 5 pigs in the Impella group, and 5 of 7 pigs in the ECMO group had ROSC (p < 0.05). Left ventricular ejection fraction at 240 min post-resuscitation was 37.5 ± 6.2% in the ECMO group vs. 23 ± 3% in the Impella group (p = 0.06). No significant difference in hemodynamic parameters was observed between the two ventricular assist devices. Conclusion: Early mechanical circulatory support appeared to improve resuscitation rates in a shockable rhythm model of cardiac arrest. This approach appears promising and should be further evaluated.

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“…Given the heterogeneity of clinical presentations, the diversity of therapeutic approaches in the absence of large-scale randomized studies with unequivocal results, the United States and European recommendations remain poorly directive and precise concerning the type and the timing of MCS (level of recommendation IIBC for European Society of Cardiology; and IIAb for American, Indian, and Canadian Heart Failure and Interventional Cardiology societies) (7,(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…In 15–20% of the cases designated as refractory CS, classical drugs are ineffective. In these cases, mechanical circulatory supports (MCS) have been developed for a dual role: first, to ensure CO to prevent or treat organ failure secondary to hypoperfusion and second, to allow the unloading of the ventricles and to promote myocardial recovery ( 5 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of a Prolonged Hemodynamic Support by the IVAC2L System in Healthy and Cardiogenic Shock Pigs

Delmas

Porterie

Jourdan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundMechanical circulatory supports are used in case of cardiogenic shock (CS) refractory to conventional therapy. Several devices can be employed, but are limited by their availability, benefit risk-ratio, and/or cost.AimsTo investigate the feasibility, safety, and effectiveness of a long-term support by a new available device (IVAC2L) in pigs.MethodsExperiments were carried out in male pigs, divided into healthy (n = 6) or ischemic CS (n = 4) groups for a median support time of 34 and 12 h, respectively. IVAC2L was implanted under fluoroscopic and TTE guidance under general anesthesia. CS was induced by surgical ligation of the left anterior descending artery. An ipsilateral lower limb reperfusion was created with the Solopath® system. Reperfusion was started after 1 h of support in healthy pigs and upon IVAC2L insertion in CS pigs. Hemodynamic and biological parameters were monitored before and during the whole period of support in each group.ResultsOccurrence of an ipsilateral lower limb ischemia was systematic in healthy and CS pigs in a few minutes after IVAC2L implantation, and could be reversed by the arterial reperfusion, as demonstrated by distal transcutaneous pressure in oxygen (TcPO2) and lactate normalization. IVAC2L support decreased pulmonary capillary wedge pressure (PCWP) (15.3 ± 0.3 vs. 7.5 ± 0.9 mmHg, p < 0.001), increased systolic blood pressure (SBP) (70 ± 4.5 vs. 101.3 ± 3.1 mmHg, p < 0.01), and cardiac output (CO) (4.0 ± 0.3 vs. 5.2 ± 0.6 l/min, p < 0.05) in CS pigs; at CS onset and after 12 h of support, without effects on heart rate or pulmonary artery pressure (PAP). Non-sustained ventricular arrhythmias were frequent at implantation (50%). A non-significant hemolysis was observed under support in CS pigs. Bleedings were frequent at the insertion and/or operating sites (30%).ConclusionLong-term support by IVAC2L is feasible and associated with a significant hemodynamic improvement in a porcine model. These preclinical data open the door for a study of IVAC2L in human ischemic CS, keeping in mind the need for systematic reperfusion of the lower limb and the associated risk of bleeding.

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Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices

Cited by 56 publications

References 118 publications

Intensive Care Management of the Cardiogenic Shock Patient

Intensive Care Management of the Cardiogenic Shock Patient

Severe Myocardial Dysfunction after Non-Ischemic Cardiac Arrest: Effectiveness of Percutaneous Assist Devices

Effectiveness and Safety of a Prolonged Hemodynamic Support by the IVAC2L System in Healthy and Cardiogenic Shock Pigs

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