Stepwise use of circulatory support devices in a patient refractory to cardiopulmonary resuscitation

Monitoring of adult patient on venoarterial extracorporeal membrane oxygenation in intensive care medicine

“…In an acute medical setting peripheral cannulation of inguinal vessels is preferred, also known as femo-femoral cannulation. Draining cannula is positioned via femoral vein (19)(20)(21)(22)(23) in the area of the right atrium and the back leading cannula is placed via femoral arteria in iliac arteria (15)(16)(17)(18)(19) (5). Due to cannulation strategy a right ventricular release is achieved as well as an adequate perfusion of visceral organs.…”

“…Since under femo-femoral ECLS retrograde aortic flow competes against antegrade ejected stroke volume, a closed aortic valve might result in cases of a minimal or missing left ventricular contraction and full ECMO power. A closed aortic valve may lead to a left ventricular dilatation with a consecutive functional mitral valve insufficiency und pulmonary back pressure as well as to the danger of left ventricular thrombus development so that in order to unload left ventricle and decrease of left ventricular preload (LVEDP) an implantation of a percutaneous cardiac support system, e.g., a left ventricular micro-axial-pump or a venting system, should be considered (19). If myocardial contraction increases during ECLS, visible by a better pump function and a more regularly opening of the aortic valve, ECLS flow rate can slowly be reduced depending on hemodynamic and clinical status.…”

Intensivmedizinisches Monitoring der extrakorporalen Herz-Kreislauf- und Lungenunterstützung

“…Wenn möglich, sollte die Gefäßpunktion sowie die Vorführung der Seldinger-Drähte sonografisch und/oder fluoroskopisch gesteuert werden. Die zu drainierende Kanüle wird dabei via V. femoralis (19)(20)(21)(22)(23) bis auf Höhe des rechten Vorhofs (oder kavoatrialer Übergang) und die zurückführende Kanüle via A. femoralis (15)(16)(17)(18)(19) bis in die A. iliaca communis platziert [5]. Durch die Kanülenanordnung resultieren entsprechend eine umgehende rechtsventrikuläre Entlastung und eine adäquate Perfusion der viszeralen Organe.…”

Risk factors for adverse outcomes after left ventricular assist device implantation and extracorporeal cardiopulmonary resuscitation

“…However, data on this approach are scant and restricted to case reports or small series of patients. 2,3 Recently, we reported results of a cohort of 279 patients after ECPR, of whom 40 underwent LVAD implantation. 4 The outcome of these 40 patients was ambivalent: Thirty-day and 1-year mortality were 30% and 60%, respectively, and thus unacceptably high.…”

“…Since patients with LVAD implantation after ECPR utilize huge medical and human resources, we sought to investigate whether their outcome could be predicted by single risk factors or those established risk scores which have been used in heart failure patients. 2,3…”