Pubblicazioni recenti - cardiogenic shock
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Percutaneous intravascular micro-axial blood pump: current state and perspective from engineering view.
J Artif Organs2024 Apr;():. doi: 10.1007/s10047-024-01433-3.
Okamoto Eiji, Mitamura Yoshinori,
Abstract
The utilization of a minimally invasively placed catheter-mounted intravascular micro-axial flow blood pump (IMFBP) is increasing in the population with advanced heart failure. The current development of IMFBPs dates back around the 1990s, namely the Hemopump with a wire-drive system and the Valvopump with a direct-drive system. The wire-drive IMFBPs can use a brushless motor in an external console unit to transmit rotational force through the drive wire rotating the impeller inside the body. The direct-drive IMFBPs require an ultra-miniature and high-power brushless motor. Additionally, the direct-drive system necessitates a mechanism to protect against blood immersion into the motor. Therefore, the direct-drive IMFBPs can be categorized into two types of devices: those with seal mechanisms or those with sealless mechanisms using magnetically coupling. The IMFBPs can be classified into two groups depending on their purpose. One group is for cardiogenic shock following a heart attack or for use in high-risk percutaneous coronary intervention (PCI), and the other group serves the purpose of acute decompensated heart failure. Both direct-drive IMFBPs and wire-drive IMFBPs have their own advantages and disadvantages, and efforts are being made to develop and improve, and clinically implement them, leveraging their own strengths. In addition, there is a possibility that innovative new devices may be invented. For researchers in the field of artificial heart development, IMFBPs offer a new area of research and development, providing a novel treatment option for severe heart failure.
© 2024. The Japanese Society for Artificial Organs.
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"Effect of pulmonary artery catheterization in patients with non-ischemic cardiogenic shock: a nationwide analysis".
Shock2024 Apr;():. doi: 10.1097/SHK.0000000000002371.
Diaz-Arocutipa Carlos, Moreno Guillermo, Gil David Galán, Nieto Sara, Romo Martín, Vicent Lourdes,
Abstract
BACKGROUND:
Pulmonary artery catheterization (PAC) has been widely used in critically ill patients, yielding mixed results. Prior studies on cardiogenic shock (CS) predominantly included patients with acute myocardial infarction. This study aims to examine the effect of PAC use in patients with non-ischemic CS.
METHODS:
This retrospective cohort study employed data from the National Inpatient Sample (NIS) database, including weighted hospitalizations of adult patients with non-ischemic CS during 2017 to 2019. In-hospital outcomes were compared between groups using inverse probability of treatment weighting.
RESULTS:
A total of 303,970 patients with non-ischemic CS were included, of whom 17.5% received a PAC during their hospitalization. The median age was 67 years (interquartile range: 57 - 77) and 61% were male. After inverse probability of treatment weighting, patients in the PAC group had significantly lower in-hospital mortality (24.8% vs. 35.3%, p
CONCLUSION:
In the real-world setting, invasive hemodynamic monitoring with PAC in patients with non-ischemic CS is associated with survival benefits and a reduction in adverse events, including reduced need for renal replacement therapy, mechanical ventilation and risk of in-hospital cardiac arrest.
Copyright © 2024 by the Shock Society.
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Fatal systemic capillary leak syndrome in a patient with a COVID-19 infection.
Intern Med2024 Apr;():. doi: 10.2169/internalmedicine.3637-24.
Kawano Hiroaki, Umeda Masataka, Honda Tomohiro, Iwasaki Ryosuke, Okano Shinji, Akashi Ryohei, Koga Tomohiro, Izumikawa Koichi, Kawakami Atsushi, Maemura Koji,
Abstract
A 29-year-old Japanese woman was admitted to our hospital with a fever, cardiogenic shock, and cardiac arrest. Laboratory data indicated multiple organ failure in addition to hemoconcentration, hypoalbuminemia, and myocardial damage. The coronary angiography findings were normal, and fulminant myocarditis was suspected. Venoarterial peripheral extracorporeal membrane oxygenation and an Impella CP left ventricular assist device were initiated, along with the administration of positive inotropic agents. However, hypovolemic shock and hypoalbuminemia progressed along with severe anemia, and the patient died 18 hours after admission. The patient was diagnosed with systemic capillary leak syndrome associated with COVID-19.
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Anesthetic Management of Intra-aortic Balloon Pump-Induced Systolic Anterior Motion of the Mitral Valve During Coronary Artery Bypass Grafting.
Cureus2024 Mar;16(3):e56815. doi: e56815.
Figaro Rachel, Thornton Imani, Scott Jeremy P, Sluhoski Joseph,
Abstract
The intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. Since its inception, the IABP has been a mainstay of cardiac support devices, utilized as a temporizing measure in patients with or prone to developing cardiogenic shock that are awaiting definitive treatment. Systolic anterior motion (SAM) of the mitral valve is a well-described phenomenon that can precipitate hemodynamic collapse by obstructing the left ventricular outflow tract in a subset of patients with cardiac pathology, most notably hypertrophic obstructive cardiomyopathy (HOCM). This report describes the case and anesthetic management of a patient who had an IABP placed for support and later developed SAM and hemodynamic compromise after induction of general anesthesia during a coronary artery bypass surgery.
Copyright © 2024, Figaro et al.
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Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry.
BMC Cardiovasc Disord2024 Apr;24(1):218. doi: 10.1186/s12872-024-03889-w.
Xu Xu, Wang Zhao, Yang Jingang, Fan Xiaohan, Yang Yuejin,
Abstract
BACKGROUND:
The coexistence of cardiac arrhythmias in patients with acute myocardial infarction (AMI) usually exhibits poor prognosis. However, there are few contemporary data available on the burden of cardiac arrhythmias in AMI patients and their impact on in-hospital outcomes.
METHODS:
The present study analyzed data from the China Acute Myocardial Infarction (CAMI) registry involving 23,825 consecutive AMI patients admitted to 108 hospitals from January 2013 to February 2018. Cardiac arrhythmias were defined as the presence of bradyarrhythmias, sustained atrial tachyarrhythmias, and sustained ventricular tachyarrhythmias that occurred during hospitalization. In-hospital outcome was defined as a composite of all-cause mortality, cardiogenic shock, re-infarction, stroke, or heart failure.
RESULTS:
Cardiac arrhythmia was presented in 1991 (8.35%) AMI patients, including 3.4% ventricular tachyarrhythmias, 2.44% bradyarrhythmias, 1.78% atrial tachyarrhythmias, and 0.73% ?2 kinds of arrhythmias. Patients with arrhythmias were more common with ST-segment elevation myocardial infarction (83.3% vs. 75.5%, P?0.001), fibrinolysis (12.8% vs. 8.0%, P?0.001), and previous heart failure (3.7% vs. 1.5%, P?0.001). The incidences of in-hospital outcomes were 77.0%, 50.7%, 43.5%, and 41.4%, respectively, in patients with ??2 kinds of arrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and atrial tachyarrhythmias, and were significantly higher in all patients with arrhythmias than those without arrhythmias (48.9% vs. 12.5%, P?0.001). The presence of any kinds of arrhythmia was independently associated with an increased risk of hospitalization outcome (??2 kinds of arrhythmias, OR 26.83, 95%CI 18.51-38.90; ventricular tachyarrhythmias, OR 8.56, 95%CI 7.34-9.98; bradyarrhythmias, OR 5.82, 95%CI 4.87-6.95; atrial tachyarrhythmias, OR4.15, 95%CI 3.38-5.10), and in-hospital mortality (??2 kinds of arrhythmias, OR 24.44, 95%CI 17.03-35.07; ventricular tachyarrhythmias, OR 13.61, 95%CI 10.87-17.05; bradyarrhythmias, OR 7.85, 95%CI 6.0-10.26; atrial tachyarrhythmias, OR 4.28, 95%CI 2.98-6.16).
CONCLUSION:
Cardiac arrhythmia commonly occurred in patients with AMI might be ventricular tachyarrhythmias, followed by bradyarrhythmias, atrial tachyarrhythmias, and ??2 kinds of arrhythmias. The presence of any arrhythmias could impact poor hospitalization outcomes.
REGISTRATION:
Clinical Trial Registration: Identifier: NCT01874691.
© 2024. The Author(s).
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Heart pump increases survival in STEMI-related cardiogenic shock.
Nat Rev Cardiol -
Cerebral embolic protection device utilization and outcomes in transcatheter aortic valve replacement: A nationally representative propensity matched analysis.
Cardiovasc Revasc Med2024 Apr;():. doi: S1553-8389(24)00147-7.
Altibi Ahmed M, Alhuneafat Laith, Jabri Ahmad, Al-Abdouh Ahmad, Ghanem Fares,
Abstract
INTRODUCTION:
In patients undergoing transcatheter aortic valve replacement (TAVR), cerebral embolic protection devices (CEPD) are used to possibly diminish the risk of periprocedural stroke. Trends and outcomes of CEPD usage in TAVR are not well characterized.
METHODS:
National readmission databases (NRD) 2017-2019 was used to identify hospital admissions for TAVR using ICD-10 codes, with versus without Sentinel CEPD. Primary outcomes of the study were in-hospital and 30-day stroke. Secondary outcomes include in-hospital mortality, 30-day mortality, 30-day readmission rate, and other procedural complications. We matched both cohorts using propensity score matching (PSM) and performed logistic regression to compute the odds ratios (ORs) and corresponding 95 % confidence intervals (CI).
RESULTS:
Out of 190,837 TAVR admissions in the United States, 10,643 (5.6 %) patients had TAVR with Sentinel CEPD. After propensity score matching, our cohort included 10,503 patients with CEPD and 10,541 without CEPD. Trends in CEPD utilization are noted in Fig. 1. In the PSM cohort, Sentinel CEPD was not associated with decreased risk of in-hospital stroke (1.9 % vs. 1.8 %, OR: 0.98, 95 % CI: 0.76-1.26, p = 0.88), 30-day stroke (2.1 % vs. 2.1 %, OR: 1.01, 95 % CI: 0.78-1.30, p = 0.96), or 30-day mortality (1.3 % vs. 1.0 %, OR: 0.74, 95 % CI: 0.51-1.07, p = 0.11) when compared to TAVR without CEPD. Other in-hospital and short-term outcomes post-TAVR were not impacted by Sentinel CEPD usage, including acute kidney injury, vascular complications, paravalvular leak, cardiogenic shock, circulatory support, or permanent pacemaker (Table 1).
CONCLUSION:
In this nationally representative cohort, Sentinel CEPD utilization during transfemoral TAVR for stroke prevention was not associated with reduced odds of in-hospital stroke, 30-day stroke, or 30-day mortality. Future studies should focus on optimizing patient selection for CEPD and establishing predictive models to identify the subset of TAVR patients with higher risk for periprocedural stroke who might benefit from CEPD.
Copyright © 2024 Elsevier Inc. All rights reserved.
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Never put off until tomorrow what you can do today: the role of early temporary mechanical circulatory support in cardiogenic shock.
Eur Heart J Acute Cardiovasc Care -
What the pediatric nurse needs to know about the Impella cardiac assist device.
Perfusion2024 Apr;39(1_suppl):95S-106S. doi: 10.1177/02676591241237761.
Borrelli Giorgia, Nittolo Ilaria, Bochicchio Chiara, Trainelli Laura, Confalone Valerio, Satta Tiziana, Cancani Federica, Kirk Richard, Amodeo Antonio, Di Nardo Matteo,
Abstract
Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.
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Clinical decision making for VA ECMO weaning in patients with cardiogenic shock A formative qualitative study.
Perfusion2024 Apr;39(1_suppl):39S-48S. doi: 10.1177/02676591241236643.
Hermens J A J, van Til J A, Meuwese C L, van Dijk D, Donker D W,
Abstract
Weaning and liberation from VA ECMO in cardiogenic shock patients comprises a complex process requiring a continuous trade off between multiple clinical parameters. In the absence of dedicated international guidelines, we hypothesized a great heterogeneity in weaning practices among ECMO centers due to a variety in local preferences, logistics, case load and individual professional experience. This qualitative study focused on the appraisal of clinicians' preferences in decision processes towards liberation from VA ECMO after cardiogenic shock while using focus group interviews in 4 large hospitals. The goal was to provide novel and unique insights in daily clinical weaning practices. As expected, we found we a great heterogeneity of weaning strategies among centers and professionals, although participants appeared to find common ground in a clinically straightforward approach to assess the feasibility of ECMO liberation at the bedside. This was shown in a preference for robust, easily accessible parameters such as arterial pulse pressure, stable cardiac index ?2.1 L/min, VTI LVOT and 'eyeballing' LVEF.
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The physiology of venoarterial extracorporeal membrane oxygenation - A comprehensive clinical perspective.
Perfusion2024 Apr;39(1_suppl):5S-12S. doi: 10.1177/02676591241237639.
Fresiello Libera, Hermens Jeannine A J, Pladet Lara, Meuwese Christiaan L, Donker Dirk W,
Abstract
Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a standard of care for severe cardiogenic shock, refractory cardiac arrest and related impending multiorgan failure. The widespread clinical use of this complex temporary circulatory support modality is still contrasted by a lack of formal scientific evidence in the current literature. This might at least in part be attributable to VA ECMO related complications, which may significantly impact on clinical outcome. In order to limit adverse effects of VA ECMO as much as possible an indepth understanding of the complex physiology during extracorporeally supported cardiogenic shock states is critically important. This review covers all relevant physiological aspects of VA ECMO interacting with the human body in detail. This, to provide a solid basis for health care professionals involved in the daily management of patients supported with VA ECMO and suffering from cardiogenic shock or cardiac arrest and impending multiorgan failure for the best possible care.
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Left ventricular unloading in patients supported with veno-arterial extra corporeal membrane oxygenation; an international EuroELSO survey.
Perfusion2024 Apr;39(1_suppl):13S-22S. doi: 10.1177/02676591241229647.
Ezad Saad M, Ryan Matthew, Barrett Nicholas, Camporota Luigi, Swol Justyna, Antonini Marta V, Donker Dirk W, Pappalardo Federico, Kapur Navin K, Rose Louise, Perera Divaka,
Abstract
INTRODUCTION:
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) improves end-organ perfusion in cardiogenic shock but may increase afterload, which can limit cardiac recovery. Left ventricular (LV) unloading strategies may aid cardiac recovery and prevent complications of increased afterload. However, there is no consensus on when and which unloading strategy should be used.
METHODS:
An online survey was distributed worldwide via the EuroELSO newsletter mailing list to describe contemporary international practice and evaluate heterogeneity in strategies for LV unloading.
RESULTS:
Of 192 respondents from 43 countries, 53% routinely use mechanical LV unloading, to promote ventricular recovery and/or to prevent complications. Of those that do not routinely unload, 65% cited risk of complications as the reason. The most common indications for unplanned unloading were reduced arterial line pulsatility (68%), pulmonary edema (64%) and LV dilatation (50%). An intra-aortic balloon pump was the most frequently used device for unloading followed by percutaneous left ventricular assist devices. Echocardiography was the most frequently used method to monitor the response to unloading.
CONCLUSIONS:
Significant variation exists with respect to international practice of ventricular unloading. Further research is required that compares the efficacy of different unloading strategies and a randomized comparison of routine mechanical unloading versus unplanned unloading.
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Eosinophilic Myocarditis Resulting in Ventricular Tachycardia Storm.
Cureus2024 Mar;16(3):e56779. doi: e56779.
Hengst Dylan, Kandah Daniel, Dervesh Ravinder, Ellerman Michael, Ugwu Justin, Goerbig-Campbell Jennifer, Campbell Dwayne,
Abstract
Eosinophilic myocarditis (EM) is a rare but potentially fatal complication of sustained eosinophilia that is characterized by eosinophilic infiltration into myocardial tissue. There are various etiologies of EM that can be classified into general categories: reactive, clonal, and idiopathic. We present a case of EM caused by chronic eosinophilic leukemia, a rare myeloproliferative neoplasm that frequently presents with sustained peripheral eosinophilia. This case displays several serious complications of EM, including recurrent ventricular tachycardia storm, cardiogenic shock, and mural thrombus formation despite anticoagulation. Diagnosis of EM can be difficult as formal diagnosis requires an endomyocardial biopsy. Once EM is suspected, identifying the underlying etiology of eosinophilia is critical for timely implementation of disease-specific therapy.
Copyright © 2024, Hengst et al.
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TAPSE/sPAP prognostic value for In-Hospital Adverse Events in Patients Hospitalized for Acute Coronary Syndrome.
Eur Heart J Cardiovasc Imaging2024 Apr;():. doi: jeae110.
Fauvel Charles, Dillinger Jean-Guillaume, Bouleti Claire, Trimaille Antonin, Tron Christophe, Chaussade Anne Solene, Thuaire Christophe, Delmas Clément, Boccara Albert, Roule Vincent, Millischer Damien, Thevenet Eugénie, Meune Christophe, Stevenard Mathilde, Charbonnel Clément, Ballesteros Laura Maitre, Pommier Thibaut, El Ouahidi Amine, Swedsky Fédérico, Martinez David, Hauguel-Moreau Marie, Schurtz Guillaume, Coisne Augustin, Dupasquier Valentin, Bochaton Thomas, Gerbaud Edouard, Puymirat Etienne, Henry Patrick, Pezel Théo, ,
Abstract
AIMS:
Although several studies have shown that the right ventricular to pulmonary artery (RV-PA) coupling, assessed by the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/sPAP) using echocardiography, is strongly associated with cardiovascular events, its prognostic value is not established in acute coronary syndrome (ACS). We aimed to assess the in-hospital prognostic value of TAPSE/sPAP among patients hospitalized for ACS in a retrospective analysis from the prospective ADDICT-ICCU study.
METHODS AND RESULTS:
481 consecutive patients hospitalized in intensive cardiac care unit (mean age 65±13 years, 73% of male, 46% STEMI) for ACS (either ST-elevation [STEMI] or non-ST-elevation [NSTEMI] myocardial infarction) with TAPSE/sPAP available were included in this prospective French multicentric study (39 centers). The primary outcome was in-hospital major adverse cardiovascular events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock and occurred in 33 (7%) patients. ROC-curve analysis identified 0.55 mm/mmHg as the best TAPSE/sPAP cut-off to predict in-hospital MACEs. TAPSE/sPAP
CONCLUSION:
A low RV-PA coupling defined as TAPSE/sPAP ratio
TRIAL REGISTRATION:
ClinicalTrials.gov Identifier: NCT05063097.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
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Haemodynamic implications of VA-ECMO vs. VA-ECMO plus Impella CP for cardiogenic shock in a large animal model.
ESC Heart Fail2024 Apr;():. doi: 10.1002/ehf2.14780.
Frederiksen Peter H, Linde Louise, Gregers Emilie, Udesen Nanna L J, Helgestad Ole K, Banke Ann, Dahl Jordi S, Jensen Lisette O, Lassen Jens F, Povlsen Amalie L, Larsen Jeppe P, Schmidt Henrik, Ravn Hanne B, Møller Jacob E,
Abstract
AIMS:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) with profound left ventricular (LV) failure is associated with inadequate LV emptying. To unload the LV, VA-ECMO can be combined with Impella CP (ECMELLA). We hypothesized that ECMELLA improves cardiac energetics compared with VA-ECMO in a porcine model of cardiogenic shock (CS).
METHODS AND RESULTS:
Land-race pigs (weight 70 kg) were instrumented, including a LV conductance catheter and a carotid artery Doppler flow probe. CS was induced with embolization in the left main coronary artery. CS was defined as reduction of ?50% in cardiac output or mixed oxygen saturation (SvO) or a SvO
CONCLUSIONS:
In a porcine model of CS, we found lower PVA, with the ECMELLA configuration compared with VA-ECMO, indicating better cardiac energetics without compromising systemic perfusion.
© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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Immediate inflammatory response to mechanical circulatory support in a porcine model of severe cardiogenic shock.
Intensive Care Med Exp2024 Apr;12(1):39. doi: 39.
Gregers Emilie, Frederiksen Peter H, Udesen Nanna L J, Linde Louise, Banke Ann, Povlsen Amalie L, Larsen Jeppe P, Hassager Christian, Jensen Lisette O, Lassen Jens F, Schmidt Henrik, Ravn Hanne B, Heegaard Peter M H, Møller Jacob E,
Abstract
BACKGROUND:
In selected cases of cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is combined with trans valvular micro axial flow pumps (ECMELLA). Observational studies indicate that ECMELLA may reduce mortality but exposing the patient to two advanced mechanical support devices may affect the early inflammatory response. We aimed to explore inflammatory biomarkers in a porcine cardiogenic shock model managed with V-A ECMO or ECMELLA.
METHODS:
Fourteen landrace pigs had acute myocardial infarction-induced cardiogenic shock with minimal arterial pulsatility by microsphere embolization and were afterwards managed 1:1 with either V-A ECMO or ECMELLA for 4 h. Serial blood samples were drawn hourly and analyzed for serum concentrations of interleukin 6 (IL-6), IL-8, tumor necrosis factor alpha, and serum amyloid A (SAA).
RESULTS:
An increase in IL-6, IL-8, and SAA levels was observed during the experiment for both groups. At 2-4 h of support, IL-6 levels were higher in ECMELLA compared to V-A ECMO animals (difference: 1416 pg/ml, 1278 pg/ml, and 1030 pg/ml). SAA levels were higher in ECMELLA animals after 3 and 4 h of support (difference: 401 ng/ml and 524 ng/ml) and a significant treatment-by-time effect of ECMELLA on SAA was identified (p?=?0.04). No statistical significant between-group differences were observed in carotid artery blood flow, urine output, and lactate levels.
CONCLUSIONS:
Left ventricular unloading with Impella during V-A ECMO resulted in a more extensive inflammatory reaction despite similar end-organ perfusion.
© 2024. The Author(s).
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Predictive value of microcirculation for pediatric extracorporeal membrane oxygenation weaning test: A monocentric prospective observational study.
Artif Organs2024 Apr;():. doi: 10.1111/aor.14754.
Suc Violette, Starck Julie, Levy Yael, Soreze Yohan, Rambaud Jerome, Léger Pierre-Louis,
Abstract
BACKGROUND:
Extracorporeal membrane oxygenation (ECMO) is widely used for children treated for refractory respiratory failures or refractory cardiogenic shock. Its duration depends on organ functions recovery. Weaning is decided using macro-circulatory tools, but microcirculation is not well evaluated. Sidestream dark-field video imaging is used to assess the perfusion of the sublingual microvascular vessels. The aim of this study was to assess the predictive value of microcirculatory indices in ECMO weaning.
METHODS:
This prospective monocentric study examined pediatric patients at Trousseau Hospital between March 2017 and December 2020. The study included all patients from 35?weeks of gestational age to 18?years old who were treated with ECMO. Children were divided into two groups: one with stability after weaning and the other with instability after weaning. We collected clinical and biological data, ventilation parameters, extracorporeal membrane oxygenation parameters, and drugs used at admission and after the weaning test. Microcirculations videos were taken after weaning trials with echocardiography and blood gas monitoring.
RESULTS:
The study included 30 patients with a median age of 29?days (range: 1-770?days) at admission, including 18 patients who received venoarterial ECMO (60%). There were 19 children in the stability group and 11 in the instability group. Macrocirculatory and microcirculatory indices showed no differences between groups. The microvascular flow index was subnormal in both groups (2.3 (1.8-2.4) and 2.3 (2.3-2.6), respectively; p?=?0.24). The microvascular indices were similar between cases of venovenous and venoarterial ECMO and between age groups.
CONCLUSION:
Microcirculation monitoring at the weaning phase did not predict the failure of ECMO weaning.
© 2024 The Authors. Artificial Organs published by International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
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Extracorporeal Life Support Use in Mixed Distributive-Obstructive Shock following an Electrical Injury: A Case Report.
J Burn Care Res2024 Apr;():. doi: irae071.
Blake Eva, Maqsood Hannan A, Dougherty Jacob M, Vercruysse Gary, Wang Stewart C, Hemmila Mark R, Sangji Naveen F,
Abstract
Electrical burn injuries can be catastrophic, threatening severe disability or mortality. We present a patient who suffered from electrical shock, requiring bilateral above knee amputations, right trans-radial amputation, renal replacement therapy, and veno-arterial extracorporeal life support (VA ECLS) therapy. While there exist reports of cases that have demonstrated the potential use of ECLS in burn patients with cardiogenic shock or acute respiratory distress syndrome (ARDS), this is a unique case of VA ECLS use for an electrical injury patient who developed mixed distributive-obstructive shock secondary to pulmonary embolism and sepsis. Given the wide variety of morbidities that can result from electrical burns, VA ECLS is a promising tool for those who require cardiopulmonary support refractory to traditional measures.
© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site?for further information please contact journals.permissions@oup.com.
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A case of cardiogenic shock due to ventricular dyssynchrony resolved by atrial pacing.
J Cardiol Cases2024 Apr;29(4):149-152. doi: 10.1016/j.jccase.2023.10.006.
Chakrala Teja S, Prakash Roshni O, Prasada Sahil, Rigger Wytch R, Vilaro Juan,
Abstract
UNLABELLED:
We present a case of a man with ischemic cardiomyopathy and single chamber implantable cardioverter-defibrillator who developed sinus arrest creating sudden dependence on right ventricular (RV) pacing. He presented with cardiogenic shock secondary to abrupt onset ventricular dyssynchrony from RV pacing, which required emergent stabilization and completely resolved with atrial pacing.
LEARNING OBJECTIVE:
To establish a basic understanding of cardiogenic shock management. To reinforce the adverse effects associated with right ventricular pacing.
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd.
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Diagnostic and Management Considerations in a High-Risk Pregnant Patient With Ischemic Cardiomyopathy.
JACC Case Rep2024 Apr;29(7):102268. doi: 102268.
Bigeh Allison, Mehta Laxmi, Lastinger Lauren,
Abstract
Ischemic heart disease is an important cause of heart failure in pregnancy. Involvement of a cardio-obstetrics team is crucial for managing high-risk pregnant patients with cardiovascular disease. We present a case of cardiogenic shock in a pregnant woman unmasking underlying multivessel obstructive coronary artery disease.
© 2024 The Authors.
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