Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction

Hamiko, Marwan; Slottosch, Ingo; Scherner, M; Gestrich, Christopher; Wahlers, Thorsten; Putensen, Christian; Mellert, Fritz; Treede, Hendrik; Dewald, Oliver; Duerr, Georg Daniel

doi:10.1111/jocs.14258

“…MCS can also be used in the case of intraoperative failure to wean the patient from cardiopulmonary bypass. 6 AMI-patients with ECMO-start after CABG had the lowest 30-day-survival (40.7%), 7 whereas preoperative and intraoperative ECMO-start was associated with signi cantly better survival reaching up to 66.7%. 8 There are several forms of MCS that can be utilized; for example, IABP, VA-ECMO, and ventricular assist devices (VAD).…”

Section: Discussionmentioning

confidence: 95%

Application of ECMO in a patient with post-cardiotomy cardiogenic shock combined with dextrocardia：case report

Zhang

¹

,

Wang

²

,

Fu

³

et al. 2022

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Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a widely-accepted salvage therapy for patients with refractory cardiogenic shock (CS). CS often presents with mirror-image dextrocardia and other cardiac abnormalities, making surgical management of CS challenging. The use of VA-ECMO and an intra-aortic balloon pump (IABP) to address CS combined with dextrocardia has not been reported previously. In this case report, we summarize our experience treating perioperative CS using VA-ECMO and IABP in a male patient with dextrocardia combined with coronary artery disease (CAD). During off-pump coronary artery bypass (OPCAB), the patient developed CS and underwent emergency transfer to on-pump coronary artery bypass (ONCAB). The patient then received ECMO and an IABP, which successfully restored hemodynamic function. The patient was eventually discharged from the hospital without further complications.

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“…MCS can also be used in the case of intraoperative failure to wean the patient from cardiopulmonary bypass [6]. AMI-patients with ECMO-start after CABG had the lowest 30-day-survival (40.7%), whereas preoperative and intraoperative ECMO-start was associated with significantly better survival reaching up to 66.7% [7,8]. There are several forms of MCS that can be utilized; for example, IABP, VA-ECMO, and ventricular assist devices (VAD).…”

Section: Discussionmentioning

confidence: 99%

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

2023

IJCMER

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Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a widely-accepted salvage therapy for patients with refractory cardiogenic shock (CS). CS often presents with mirror-image dextrocardia and other cardiac abnormalities, making surgical management of CS challenging. The use of VA-ECMO and an intra-aortic balloon pump (IABP) to address CS combined with dextrocardia has not been reported previously. In this case report, we summarize our experience treating perioperative CS using VA-ECMO and IABP in a male patient with dextrocardia combined with coronary artery disease (CAD). During off-pump coronary artery bypass (OPCAB), the patient developed CS and underwent emergency transfer to on-pump coronary artery bypass (ONCAB). The patient then received ECMO and an IABP, which successfully restored hemodynamic function. The patient was eventually discharged from the hospital without further complications.

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“…Similar results were seen in patients with acute myocardial infarction and the need of ECLS. Lactate-increase greater than 4 mmol/L seems to be a helpful threshold to trigger the timely onset of ECLS-therapy for these patients [ 30 ]. In our study, deceased patients had significant elevated peak serum lactate level.…”

Section: Discussionmentioning

confidence: 99%

Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients

Rissel

¹

,

Koelm

²

,

Schepers

³

et al. 2022

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The use of extracorporeal life support (ECLS) as part of cardio-circulatory support has increased rapidly in recent years. Severe hyperlactatemia is not uncommon in this group of patients. Lactate peak concentrations and lactate clearance have already been identified as independent marker for mortality in critical ill patients without mechanical device support. The aim of this study was to determine a supposed correlation between the variables lactate peak concentration and clearance in the blood and mortality in the ECLS context. Therefore, a total of 51 cardiac surgery ICU patients with ECLS therapy were included in this retrospective, clinical observational study (survivors n = 23; non-survivors n = 28). Lactate measurement was performed before, during and after ECLS therapy. Further, common ICU scores (SAPSII, SOFA, TISS28), the rates of transfusion and the different vasopressor therapies will be compared. Significant elevated peak lactate levels and poor lactate clearance were associated with higher mortality during ECLS therapy (p < 0.001). Deceased patients had higher SAPSII scores (p < 0.001), received more transfusions (p < 0.001) and presented with higher rates of epinephrine (p < 0.001). In conclusion, hyperlactatemia during ECLS therapy is a time sensitive emergency. Lactate cannot be cleared in all patients. Reversible causes should be explored and treated. In cases where the cause is irreversible, the prognosis of elevated lactate concentrations and reduced clearance is very poor.

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Timely extracorporeal membrane oxygenation assist reduces mortality after bypass surgery in patients with acute myocardial infarction

Cited by 11 publications

References 31 publications

Application of ECMO in a patient with post-cardiotomy cardiogenic shock combined with dextrocardia：case report

Application of ECMO in a patient with post-cardiotomy cardiogenic shock combined with dextrocardia：case report

Application of ECMO in a Patient with Post-Cardiotomy Cardiogenic Shock Combined with Dextrocardia: Case Report

Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients

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