Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team

Guenther, S.; Theiß, Hans; Fischer, Matthias; Sattler, Stefan; Peterß, Sven; Born, F.; Pichlmaier, Maximilian; Maßberg, Steffen; Hagl, Christian; Khaladj, Nawid

doi:10.1093/icvts/ivt505

Cited by 57 publications

(39 citation statements)

References 26 publications

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“…15 and 17 French size) worldwide. Several authors and clinical trials have reported successful patient outcomes and uncomplicated ECMO runs with such reduced cannula calibers. The reduced size is certainly an advantage, particularly in percutaneously performed cannulation, facilitating cannula placement and withdrawal.…”

Section: Cannulation Techniquesmentioning

confidence: 99%

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Sorokin

MacLaren

Vidanapathirana

et al. 2017

European J of Heart Fail

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Extracorporeal membrane oxygenation (ECMO) is becoming a common procedure to support patients with severe cardio-circulatory or respiratory failure as well as in case of combined compromise of the two systems. Deciding which ECMO configuration and proceeding with an uneventful implantation, however, may present minor or major shortcomings. Cannulation techniques should be tailored to specific patient conditions to provide sufficient regional and systemic perfusion, both of which must be comprehensively monitored. Changes in the patient's status or suboptimal ECMO-related support, however, may occur and should trigger re-appraisal of the cannulation strategy and circuit configuration. This dynamic management, based around the adequacy of end organ perfusion and patient requirements, may dictate ECMO configuration and cannulation changes. In these circumstances, adjunct of a cannula in the venous or arterial vasculature may represent a mandatory procedure to solve unfavorable hemodynamic status or enhance ECMO efficiency. These type of ECMO configurations, different from basic one, and called hybrid configurations, may represent, therefore, a critical aspect of optimal ECMO management towards optimized and successful temporary support. The aim of this review is to critically appraise and summarize the existing literature on adult ECMO configuration including cannulation strategies and circuit arrangement, and highlighting more complex pattern required in some specific clinical settings.

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Section: Cannulation Techniquesmentioning

confidence: 99%

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Sorokin

MacLaren

Vidanapathirana

et al. 2017

European J of Heart Fail

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“…22 Acute coronary syndrome complicated by shock is associated with high mortality despite the use of percutaneous support devices. 23,24 Previously reported discharge rates in selected small case studies were ≈30 to 40%. 25,26 In this series, coronary patients requiring ECMO had discharge rates of 35% regardless of whether CABG was performed.…”

Section: Survival Of Ecmo Use In Adults 2431mentioning

confidence: 99%

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

et al. 2016

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As a result of many "miraculous" experiences, intensive care facilities everywhere in Taiwan are adopting ECMO technology. 13,14 The Taiwan National Health Insurance (NHI) initiated reimbursement for the high costs of ECMO therapy in 2002, further supporting its rapidly expanding implementation in the years since. The criteria for instituting ECMO in adult patients included cardiogenic shock of various origins, respiratory failure (defined as Pao 2 <60 mm Hg under 100% Fio 2 , CO 2 retention, or a bridge to lung transplantation) resulting from infectious or noninfectious processes, airway injury, and hypothermia (core temperature ≤30°C).15 ECMO is most used as a last resort for patients with severe refractory shock. The Taiwan NHI Background-Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for patients with severe acute cardiopulmonary failure. The objective of this study was to examine the survival outcomes for patients who received ECMO. Methods and Results-Adult patients who received ECMO from September 1, 2002, to December 31, 2012 from the Taiwan National Health Insurance Database associated with coronary artery bypass graft surgery, myocardial infarction/cardiogenic shock, injury, and infection/septic shock. A Cox regression model was used to determine hazard ratios and to compare 30-day and 1-year survival rates with the myocardial infarction/cardiogenic shock group used as the reference. The mean±SD age of the 4227-patient cohort was 57±17 years, and 72% were male. The overall mortalities were 59.8% and 76.5% at 1 month and 1 year. Survival statistics deteriorated sharply when ECMO was required for >3 days. Acute (30-day) survival was more favorable in the infection/septic shock (n=1076; hazard ratio, 0.61; 95% confidence interval, 0.55-0.67), coronary artery bypass graft surgery (n=1077; hazard ratio, 0.68; 95% confidence interval, 0.61-0.75), and injury (n=369, hazard ratio, 0.82; 95% confidence interval, 0.70-0.95) groups. The extended survival rapidly approached an asymptote near 20% for the infection/septic shock, myocardial infarction/cardiogenic shock (n=1705), and coronary artery bypass graft surgery groups. The pattern of survival for the injury group was somewhat better, exceeding 30% at year-end. Conclusions-Regardless of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses.Those in the trauma group had somewhat better outcomes. Determining the efficacy and cost-effectiveness of ECMO should be a critical future goal. Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.Received August 22, 2015; accepted April 19, 2016. claims database contains extensive clinical data obtained during the roll out of this therapeutic modality and thus allows the study of the outcomes of patients on ECMO. Despite the efficacy of prompt ECMO support as an acute lifesaving strategy in cardiovascular emergencies, the overall mortality associated with cardiogenic shock...

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“…Several recent studies [20,21,22 & , [23][24][25] have suggested that ECPR may be effective for patients with refractory inhospital cardiac arrest (IHCA). The main characteristics of the studies reporting outcome of ECPR in series of cases of IHCA are reported in Table 1 [ In their landmark study, the largest trial in the field, Chen et al [21] reported a cumulative 30-day survival rate of 34%.…”

Section: Extracorporeal Membrane Oxygenation For Inhospital Cardiac Amentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation

Fagnoul

Combes

Backer

2014

Current Opinion in Critical Care

130

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This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.

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Percutaneous extracorporeal life support for patients in therapy refractory cardiogenic shock: initial results of an interdisciplinary team

Cited by 57 publications

References 26 publications

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

Extracorporeal cardiopulmonary resuscitation

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