Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock

Aïssaoui, Nadia; Luyt, Charles Edouard; Leprince, Pascal; Trouillet, J.; Léger, Philippe; Pavie, Alain; Diebold, B.; Chastre, Jean; Combes, Alain

doi:10.1007/s00134-011-2358-2

Cited by 299 publications

(314 citation statements)

References 24 publications

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“…Data from the ELSO registry showed survival rate of 39% in patients having cardiogenic shock [4]. Similar results were reported by Aissaoui et al [21], Sakamoto et al [22], and authors of many other case series or smaller studies. In the presented study, 28% patients had positive blood cultures.…”

Section: Discussionsupporting

confidence: 66%

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

Musiał

Moncznik

et al. 2016

Kardiol Pol

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A b s t r a c tBackground: Patients suffering from cardiogenic shock, with no response to conventional therapy, may significantly improve when put on support devices such as extracorporeal membrane oxygenation (ECMO), which maintains systemic and pulmonary circulation, and decongests the heart. This publication presents authors' own experience in qualifying and treating patients with cardiogenic shock, with the use of veno-arterial (VA) ECMO modality. Aim:The main goal of the study was to analyse factors influencing outcome of VA ECMO therapy in patients with cardiogenic shock. Survival data were compared for patients surviving treatment (n = 12, 41%), and for patients who died while VA ECMO. Methods:Retrospective study included all patients treated between February 2009, when ECMO was first used in the clinic, and March 2015. Of those, 29 patients were treated with VA ECMO for respiratory support. Mean patient age was 42 years; 19 (66%) patients were male, and 10 (34%) patients were female.Results: Total in-hospital mortality rate was 59% (17/29). No difference was observed as to patient age, sex, body height, mode of hospital admission, comorbidities or left ventricular ejection fraction at hospital admission, when comparing survivors and patients who died despite treatment. The following parameters were analysed: number of days on VA ECMO, troponin levels during first days from treatment onset, platelet transfusions, and duration of mechanical ventilation. No significant differences were observed between the groups. Surviving patients were significantly longer hospitalised (p = 0.016), including a longer stay in the intensive care unit (p = 0.03). Conclusions:VA ECMO is an acceptable therapy for patients in a severe state of cardiogenic shock. In-hospital mortality rate was 59%, and 41% patients (12 subjects) were successfully treated with VA ECMO in course of cardiogenic shock.

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Section: Discussionsupporting

confidence: 66%

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

Musiał

Moncznik

et al. 2016

Kardiol Pol

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“…[49][50][51] Although promising, using historical controls rather than a prospective randomised study does not account for other potential temporal advances in management.…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

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CoronaryCardiogenic shock is a clinical condition of inadequate end-organ perfusion due to cardiac dysfunction (see Table 1). It most commonly occurs in the setting of acute MI with left ventricular failure (~80 % cases), 1,2 but can also be caused by right ventricular infarction or late mechanical complications, such as acute mitral regurgitation or ventricular rupture (septal or free wall). Non-infarct-related cardiogenic shock is comparatively rare, and may result from decompensated valvular heart disease and arrhythmias, to name a few mechanisms.The pathophysiology of cardiogenic shock is complex. Myocardial ischaemia induces marked depression of myocardial contractility, this sets into motion a downward spiral of reduced cardiac output and hypotension, which in turn drives further myocardial ischaemia. Incidence and Prognosis of Cardiogenic ShockCardiogenic shock complicates 5-10 % of acute MI cases, and despite advances in acute care there remains the same incidence (~60,000-70,000 patients per year in Europe). 2,4 Historically, MI complicated by cardiogenic shock was associated with a mortality rate of 80-90 %. 5 However, with advances in coronary reperfusion techniques over the past few decades, especially with the introduction of primary percutaneous coronary intervention (PCI), the mortality rate has improved to below 50 %. 4,[6][7][8][9][10][11][12] The trend towards better outcomes may also be due to greater awareness of the need for timely treatment, improvements in the medical care of haemodynamically unstable patients as well as the use of mechanical support devices, although this has not yet been clearly demonstrated.Despite this high mortality rate, it is important to note that patients with cardiogenic shock who survive to discharge have a long-term outcome similar to that of patients without cardiogenic shock, with a good functional outcome at 1 year. 13,14 This highlights the importance of improving the chance of early survival among patients in cardiogenic shock. Management Myocardial ReperfusionThere is evidence that the high mortality rates associated with cardiogenic shock have improved over time. 7,9,11,15,16 This benefit is thought to be due to increased use of coronary revascularisation strategies, which, by restoring flow to the ischaemic myocardium, can limit infarct size as well as interrupt the downward spiral that characterises cardiogenic shock. 7,9,15 As such, the cornerstone of the management of cardiogenic shock complicating acute MI is prompt revascularisation, as highlighted in AbstractCardiogenic shock complicates approximately 5-10 % of all MI events and remains the most common cause of death among MI cases. Over the past few decades, the mortality rate associated with cardiogenic shock has decreased with the introduction of early revascularisation, although there are limited data for patients with triple-vessel disease and left main stem disease. In more recent years, there have been a number of advances in the mechanical circulatory support devices that can help improv...

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“…The most comprehensive percutaneously inserted mechanical support is There are non-randomised data using historic controls suggesting that ECMO use for patients with myocardial infarction related cardiogenic shock can improve survival [49][50][51] . Although promising, using historic controls rather than a prospective randomised study does not account for other potential temporal advances in management.…”

Section: -Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Joseph¹,

Patterson²,

Arri³

et al. 2016

Interventional Cardiology Review

View full text Add to dashboard Cite

Abstract:Cardiogenic shock complicates approximately 5-10% of all myocardial infarction and remains the most common cause of death amongst these patients. Over the past few decades, the mortality associated with cardiogenic shock has improved with the introduction of early revascularization although there is limited data in patients with triple-vessel disease and left main stem disease. In more recent years, there have been a number of advances in the mechanical circulatory support devices that can help improve the haemodynamics of patients in cardiogenic shock. Despite these advances, together with progress in the use of inotropes and vasopressors, cardiogenic shock remains associated with a high morbidity and mortality. This review will outline the management of cardiogenic shock complicating acute myocardial infarction with major focus on revascularization techniques and the use of mechanical circulatory support devices.

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Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock

Cited by 299 publications

References 24 publications

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

Veno-arterial extracorporeal membrane oxygenation for short-term mechanical circulation support in adults with cardiogenic shock: a single centre experience

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

Primary Angioplasty For Patients in Cardiogenic Shock: Optimal Management

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