Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation With and Without Intra-Aortic Balloon Pump

Add-on Therapies in VA-ECMO for Cardiogenic Shock: The Heart Recovers, Yet Other Organs Suffer

“…We read with interest the recent publication by Björnsdottir et al that compares single therapy of venoarterial extracorporeal membrane oxygenation (VA ECMO) with the concomitant use of VA ECMO and an intra-aortic balloon pump. 1 As described in this paper and elsewhere, increased afterload due to retrograde flow from VA ECMO can lead to left ventricular (LV) distension, cause subendocardial ischemia, or prevent aortic valve opening with subsequent thrombosis and embolic events. As a result, the goal of unloading the LV through the use of two mechanical devices is growing in popularity.…”

“…4,5 However, as seen in the current and other studies, LV unloading with the concomitant use of VA ECMO and an intra-aortic balloon pump yields more conflicting results. 1,[6][7][8] Less LV unloading occurs with IABP compared with Impella®, but this intervention can still facilitate cardiac recovery, as evident from a higher successful weaning rate observed by the authors. 9 However, any potential survival benefit of this approach may be negated by a higher rate of vascular complications.…”

“…9 However, any potential survival benefit of this approach may be negated by a higher rate of vascular complications. 1,7,8 Complications such as bleeding and thrombosis, which are associated with "add-on" devices to unload the LV are associated with haemorrhagic stroke or thromboembolic events and can lead to long-term disability, and mortality. Lastly, add-on therapies are expensive; in particular the concomitant use of ECMO and Impella® remains a luxury of wealthier countries.…”

Not So Perfect: Radiofrequency Identification Chip Detection Failure

“…We read with interest the recent publication by Bj€ ornsdottir et al that compared single therapy of venoarterial extracorporeal membrane oxygenation (VA ECMO) with the concomitant use of VA ECMO and an intra-aortic balloon pump (IABP). 1 As described in this paper and elsewhere, increased afterload due to retrograde flow from VA ECMO can lead to left ventricular (LV) distention, cause subendocardial ischemia, or prevent aortic valve opening, with subsequent thrombosis and embolic events. As a result, the goal of unloading the left ventricle through the use of 2 mechanical devices is growing in popularity.…”

“…One study found 69% of patients needed redo surgery, and nearly 2% of patients died. 1 It is estimated that as many as 1 in 1,000-to-5,500 surgeries have a retained surgical item, most commonly a surgical sponge. 2,3 Manual counting of devices by 2 people is the most widely used technique worldwide, but is prone to human error.…”