Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Lifeline of Modern Day CICU

Rali, Aniket S; Chandler, Jonathan; Sauer, Andrew J.; Solomon, Michael A.; Shah, Zubair

doi:10.1177/0885066619894541

Cited by 9 publications

(8 citation statements)

References 107 publications

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“…Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) is an important circulatory support to rescue patients with refractory cardiogenic shock ( 1 , 2 ). However, the use of V-A ECMO can also lead to various complications ( 3 , 4 ), such as infection, hemorrhage, lung injury and skeletal muscle atrophy ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

“…Patient’s functional cardiac reserve, which was used to overcome afterload, is now converted to cope with the increased preload. Therefore, it has two main effects: ( 1 ) blood flow reaching the left heart will increase accordingly and move the operating point along the Frank-Starling curve to the right; ( 2 ) decreased retrograde device flow reduces afterload and thus shifts the Frank-Starling curve upward ( Figure 1B ). The combined effect is a shift of the heart’s operating point to the upper right.…”

Section: Introductionmentioning

confidence: 99%

“…Before formal clinical application can be made, several studies should be performed to provide more evidence. ( 1 ) in vitro simulation tests: digital cardiovascular system models ( 15 ) or the mock circulatory loops ( 16 ) could be used to simulate the conversion ratios corresponding to FCT performed with different cardiac function reserves. ( 2 ) Animal models: In the animal V-A ECMO model, we can place a variety of pressure and flow transducers and perform detailed transesophageal echocardiographic monitoring to assess whether the cardiovascular response, when performing FCT under different cardiac functions, is consistent with that predicted by the in vitro model.…”

Section: Introductionmentioning

confidence: 99%

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Weaning from venous-arterial extracorporeal membrane oxygenation: The hemodynamic and clinical aspects of flow challenge test

Luo

Zhang²,

Hou³

et al. 2022

Front. Med.

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The cardiac function reserve is crucial for the successful weaning of V-A ECMO. During the V-A ECMO weaning phase, the gradual reduction in pump flow converts the blood flow originally driven by the pump to native cardiac output and also transforms afterload (caused by retrograde flow) into ventricular preload, thus introducing a “flow challenge” to the native heart. In this perspective, we propose to use this flow challenge as a test to simulate the preload-to-afterload conversion to assess cardiac functional reserve quantitatively. With this short article we offer the hemodynamic and clinical aspects regarding the flow challenge test.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Weaning from venous-arterial extracorporeal membrane oxygenation: The hemodynamic and clinical aspects of flow challenge test

Luo

Zhang²,

Hou³

et al. 2022

Front. Med.

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“…1 Among different configurations, veno-arterial (V-A) ECMO can provide hemodynamic support for patients with hemodynamic compromise. 2,3 The primary indications of V-A ECMO include cardiac arrest, refractory multifactorial cardiogenic shock (CS), refractory ventricular tachycardia, failure to wean off cardiopulmonary bypass and a variety of infrequent indications. 4 In China, V-A ECMO has not been applied generally until the early 21st century.…”

Section: Introductionmentioning

confidence: 99%

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019

et al. 2021

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Introduction: Extracorporeal membrane oxygenation (ECMO) is an imperative short-term cardiopulmonary support device now. We aimed to provide a single-center experience of veno-arterial (V-A) ECMO management and identify the risk factors of in-hospital mortality. Methods: We conducted a retrospective review of adult patients who received V-A ECMO between 2009 and 2019 in a cardiovascular disease center. The risk factor analysis of in-hospital mortality was conducted. Results: The study reviewed 236 patients, with an overall survival rate of 68.2%. The survivors’ blood lactate concentration is significantly lower than non-survivors [7.4 (7.8) vs 11.1 (9.7), p = 0.002]. Patients who received heart transplantation were with higher in-hospital survival rate. Survivors developed less hepatic dysfunction, acute kidney injury and myocardial damage [23 (14.3%) vs 19 (25.3%), p = 0.039; 81 (50.3%) vs 51 (68%), p = 0.011; 24 (14.9%) vs 22 (29.3%), p = 0.009, respectively], with higher rate of continuous renal replacement therapy (CRRT) [56 (34.8%) vs 53 (70.7%), p < 0.001]. Fewer survivors’ 24 hours and total chest drainage was over 1000 mL, and the rate of re-exploration as well as red blood cell and platelet transfusion were lower in survivors. In multivariate analysis, female, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and 24 hours chest drainage ⩾ 1000 mL were risk factors of early mortality. Conclusions: By providing a general description of V-A ECMO practice at a single-center in China. Post-heart transplant graft failure was associated with numerically, the greatest survival in our practice. Furthermore, female sex, pre-ECMO blood lactate concentration, hyperlipidemia, CRRT, and high blood loss in chest drains are predictors of mortality in patients who undergo V-A ECMO.

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“…1 Despite these advancements, morbidity and mortality for patients requiring ECMO support remain high. 1,2…”

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confidence: 99%

Adult Highlights From the Extracorporeal Life Support Organization Registry: 2017–2022

Rali,

Abbasi,

Alexander

et al. 2023

ASAIO Journal

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The Extracorporeal Life Support Organization (ELSO) registry captures clinical data and outcomes on patients receiving extracorporeal membrane oxygenation (ECMO) support across the globe at participating centers. It provides a very unique opportunity to benchmark outcomes and analyze the clinical course to help identify ways of improving patient outcomes. In this review, we summarize select adult ECMO articles published using the ELSO registry over the past 5 years. These articles highlight innovative utilization of the registry data in generating hypotheses for future clinical trials. Members of the ELSO Scientific Oversight Committee can be found here: https://www.elso.org/registry/socmembers.aspx.

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Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: Lifeline of Modern Day CICU

Cited by 9 publications

References 107 publications

Weaning from venous-arterial extracorporeal membrane oxygenation: The hemodynamic and clinical aspects of flow challenge test

Weaning from venous-arterial extracorporeal membrane oxygenation: The hemodynamic and clinical aspects of flow challenge test

Outcomes from adult veno-arterial extracorporeal membrane oxygenation in a cardiovascular disease center from 2009 to 2019

Adult Highlights From the Extracorporeal Life Support Organization Registry: 2017–2022

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