Three Cases of LMT-STEMI with Cardiogenic Shock Under ECPELLA Support with Different Levels of Left Ventricular Unloading

Unoki, Takashi; Saku, Keita; Kametani, Motoko; Yufu, Tetsuo; Yamamuro, Megumi; Taguchi, Eiji; Sawamura, Tadashi; Nakao, Kōichi; Sakamoto, Tomohiro

doi:10.7793/jcad.29.23-00001

Journal of Coronary Artery Disease

2023

DOI: 10.7793/jcad.29.23-00001

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Three Cases of LMT-STEMI with Cardiogenic Shock Under ECPELLA Support with Different Levels of Left Ventricular Unloading

Takashi Unoki

Keita Saku

Motoko Kametani

et al.

Abstract: A 64-year-old man was transported to the emergency room (ER) with chest pain and respiratory distress. The patient exhibited hypoxia and restlessness in the ER and subsequently experienced cardiac arrest with pulseless electrical activity. Return of spontaneous circulation (ROSC) was achieved within several minutes by conventional cardiopulmonary resuscitation (CPR). The patient was diagnosed with ST-elevation myocardial

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2024

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Cited by 3 publications

References 17 publications

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Impact of ECPELLA support on 1-year outcomes and myocardial damage in patients with acute myocardial infarction and refractory cardiogenic shock: A single-center retrospective observational study

Unoki,

Nakayama,

Saku

et al. 2024

Journal of Cardiology

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Impact of ECPELLA support on 1-year outcomes and myocardial damage in patients with acute myocardial infarction and refractory cardiogenic shock: A single-center retrospective observational study

Unoki,

Nakayama,

Saku

et al. 2024

Journal of Cardiology

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The impact of ECPELLA on haemodynamics and global oxygen delivery: a comprehensive simulation of biventricular failure

Matsushita,

Saku,

Nishikawa

et al. 2024

ICMx

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Background ECPELLA, a combination of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella, a percutaneous left ventricular (LV) assist device, has emerged as a novel therapeutic option in patients with severe cardiogenic shock (CS). Since multiple cardiovascular and pump factors influence the haemodynamic effects of ECPELLA, optimising ECPELLA management remains challenging. In this study, we conducted a comprehensive simulation study of ECPELLA haemodynamics. We also simulated global oxygen delivery (DO2) under ECPELLA in severe CS and acute respiratory failure as a first step to incorporate global DO2 into our developed cardiovascular simulation. Methods and results Both the systemic and pulmonary circulations were modelled using a 5-element resistance‒capacitance network. The four ventricles were represented by time-varying elastances with unidirectional valves. In the scenarios of severe LV dysfunction, biventricular dysfunction with normal pulmonary vascular resistance (PVR, 0.8 Wood units), and biventricular dysfunction with high PVR (6.0 Wood units), we compared the changes in haemodynamics, pressure–volume relationship (PV loop), and global DO2 under different VA-ECMO flows and Impella support levels. Results In the simulation, ECPELLA improved total systemic flow with a minimising biventricular pressure–volume loop, indicating biventricular unloading in normal PVR conditions. Meanwhile, increased Impella support level in high PVR conditions rendered the LV–PV loop smaller and induced LV suction in ECPELLA support conditions. The general trend of global DO2 was followed by the changes in total systemic flow. The addition of veno-venous ECMO (VV-ECMO) augmented the global DO2 increment under ECPELLA total support conditions. Conclusions The optimal ECPELLA support increased total systemic flow and achieved both biventricular unloading. The VV-ECMO effectively improves global DO2 in total ECPELLA support conditions.

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Is Salvage Coronary Artery Bypass Grafting Justified?

Sugiyama,

Watanuki,

Tochii

et al. 2024

Journal of Coronary Artery Disease

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Three Cases of LMT-STEMI with Cardiogenic Shock Under ECPELLA Support with Different Levels of Left Ventricular Unloading

Cited by 3 publications

References 17 publications

Impact of ECPELLA support on 1-year outcomes and myocardial damage in patients with acute myocardial infarction and refractory cardiogenic shock: A single-center retrospective observational study

Impact of ECPELLA support on 1-year outcomes and myocardial damage in patients with acute myocardial infarction and refractory cardiogenic shock: A single-center retrospective observational study

The impact of ECPELLA on haemodynamics and global oxygen delivery: a comprehensive simulation of biventricular failure

Is Salvage Coronary Artery Bypass Grafting Justified?

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