Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock

Schrage, Benedikt; Burkhoff, Daniel; Rübsamen, Nicole; Becher, Peter Moritz; Schwarzl, Michael; Bernhardt, A.; Grahn, Hanno; Lubos, Edith; Söffker, Gerold; Clemmensen, Peter; Reichenspurner, Hermann; Blankenberg, Stefan; Westermann, Dirk

doi:10.1016/j.jchf.2018.09.009

Cited by 124 publications

(108 citation statements)

References 22 publications

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“…Alongside these hemodynamic features, the use of an axial flow pump may provide a circulatory support while weaning from VA-ECMO. The possibility of reducing the duration of ECLS has been reported by Scharge et al [50], however, in the experience of Pappalardo et al [48], the association of Impella and VA-ECMO prolonged the time of support but provided a successful recovery of patients who might not have survived under VA-ECMO treatment alone. The use of Impella has been associated with a significant risk of severe bleeding, vascular complications and cerebral stroke [53,54].…”

Section: Ecpellamentioning

confidence: 98%

“…The use of Impella in combination with VA-ECMO (also known as ECPELLA/ECMELLA) has been shown to provide improved weaning and survival rates compared to ECMO alone strategy and to established risks scores [47][48][49][50]. The addition of a continuous flow vent reduces LV volumes and pressures.…”

Section: Ecpellamentioning

confidence: 99%

“…In this situation a flat systemic pressure line is a sign of maximal unloading. Secondary changes in myocardial contractility and peripheral resistance may further enhance the LV unloading [26,50]. The Impella can also reduce RV afterload and facilitate RV output and pulmonary blood flow with improvement in gas exchange [51,52].…”

Section: Ecpellamentioning

confidence: 99%

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Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Kowalewski

Malvindi

Zieliński³

et al. 2020

JCM

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During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82-0.93; p < 0.0001; I 2 = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21-1.51; p < 0.00001; I 2 = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68-0.83; p < 0.0001; I 2 = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with Abstract Structured summary 2Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.

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Section: Ecpellamentioning

confidence: 98%

Section: Ecpellamentioning

confidence: 99%

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Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Kowalewski

Malvindi

Zieliński³

et al. 2020

JCM

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“…In a retrospective study including 259 VA-ECMO patients, the 104 patients who received IABP had a lower frequency of hydrostatic pulmonary edema and more days off mechanical ventilation under VA-ECMO (31). LV unloading using Impella (2.5 or CP) in addition to VA-ECMO was successfully used in 106 patients with a 30-day survival of 35.8%, higher than predicted by SAVE (20%) or SAPS II score (6.9%) with a marked decreased of pulmonary capillary wedge pressure after addition of the device to VA-ECMO (34,35). Future randomized studies are warranted to determine if these combination strategies are superior to stand-alone devices.…”

Section: Left Ventricle Unloadingmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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Purpose of review: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications and discusses the results of recent case series and trials. Recent findings: VA-ECMO is utilized as a bridge to "decision" that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, refractory cardiac arrest are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

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“…Recently, ECPR became popular, and its efficacy has been reported largely from Asia. Although VA-ECMO support stabilizes CS and CA, it can cause further impairment or delay in LV function because retrograde aortic flow due to VA-ECMO increases LV afterload 9,32) .…”

Section: The Role and Efficacy Of Va-ecmo In Ecprmentioning

confidence: 99%

The Role and Efficacy of Peripheral Veno-arterial Extracorporeal Membrane Oxygenation in Treating Cardiogenic Shock and Cardiac Arrest

Tada

Kadota

2019

Journal of Coronary Artery Disease

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Cardiogenic shock (CS) complicates acute myocardial infarction (AMI) with an incidence from 5% to 10%, and is a main cause of death in patients with acute cardiovascular disease including AMI. Short-term mortality associated with CS may approach nearly 30% to 45% in the contemporary era. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may represent the final option for severe CS that is refractory to medical therapy. Peripheral VA-ECMO can be initiated percutaneously and promptly via femoral artery and femoral vein access, and is widely used for CS and CA in emergency situations. In this review, we describe the role and efficacy of peripheral VA-ECMO in treating CS and CA.

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Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock

Cited by 124 publications

References 22 publications

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

The Role and Efficacy of Peripheral Veno-arterial Extracorporeal Membrane Oxygenation in Treating Cardiogenic Shock and Cardiac Arrest

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