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Full-Text Articles in Cardiology
Hemoadsorption With Cytosorb As Part Of A Strategy To Improve Outcomes In Patients On Extracorporeal Membrane Oxygenation, Ruzica Mrkonjic
Hemoadsorption With Cytosorb As Part Of A Strategy To Improve Outcomes In Patients On Extracorporeal Membrane Oxygenation, Ruzica Mrkonjic
The VAD Journal
The exposure of a patient’s blood to the non-endothelialized surface of the extracorporeal membrane oxygenation (ECMO) system results in the production of pro-inflammatory and anti-inflammatory cytokines. This imbalance in pro- and anti-inflammatory cytokines leads to inflammatory response syndrome, which contributes to edema, vasoplegia, and multiple organ failure among other complications. Hemoadsorption therapy, with the use of CytoSorb® (CytoSorbents) has emerged as a well-accepted treatment option that helps control pro-inflammatory response and improve outcomes for patients on ECMO. However, studies have shown that the potential of hemoadsorption is controversial and that it is crucial for clinicians to weigh the pros …
An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj
An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj
Journal of Shock and Hemodynamics
Coronary artery vasospasms may occur in one or multiple coronary arteries, typically causing transient chest pain or angina. Although rare, it can lead to lethal cardiac arrhythmias, cardiac arrest, or cardiogenic shock and is often misdiagnosed. We report a case of a young man with an atypical presentation of generalized coronary vasospasm leading to cardiac arrest and subsequent cardiogenic shock. The patient required support with veno-arterial extracorporeal membrane oxygenation and Impella. We discuss the risk factors, diagnosis, and treatment of this rare condition.
Thrompella: Acute Impella Thrombosis During Ecpella Support, Faris Araj, Hurst M. Hall, Amy E. Hackmann
Thrompella: Acute Impella Thrombosis During Ecpella Support, Faris Araj, Hurst M. Hall, Amy E. Hackmann
The VAD Journal
We present a case of acute Impella thrombosis during Ecpella support in a 48-year-old man listed for a heart transplant. After two weeks of Ecpella support, echocardiography revealed a 2.6 x 1.1 cm mobile thrombus attached to the Impella inlet (Video). The Impella and attached thrombus were pulled across the aortic valve into the descending aorta and removed without systemic thromboembolism. Due to the ongoing need for left ventricular venting, a new Impella CP was placed.
Quality Assurance In Extracorporeal Membrane Oxygenation Patients, Ruzica Mrkonjic
Quality Assurance In Extracorporeal Membrane Oxygenation Patients, Ruzica Mrkonjic
The VAD Journal
The selection of patients for extracorporeal membrane oxygenation (ECMO) support is a critical component of any perfusion program. Teams must evaluate when to start the support, how long to support the patient, and when is the ideal time to wean. The timing of ECMO support is debated. While some programs emphasize prompt timing, others suggest the conservative approach is better (>7 hours). Delaying ECMO support could increase complications; thus, more evidence has been attained for prompt support. Importantly, complications are common with ECMO support. Despite advances in ECMO support over the last ten years, bleeding remains a high risk. …
Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (Lava-Ecmo): Percutaneous Bi-Atrial Drainage To Avoid Pulmonary Edema In A Patient With Left Ventricular Systolic Dysfunction, Kenneth R. Dulnuan, Joseph B. Zwischenberger, John G. Gurley, Maya Guglin
Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation (Lava-Ecmo): Percutaneous Bi-Atrial Drainage To Avoid Pulmonary Edema In A Patient With Left Ventricular Systolic Dysfunction, Kenneth R. Dulnuan, Joseph B. Zwischenberger, John G. Gurley, Maya Guglin
The VAD Journal
Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used in patients with severe cardiogenic shock refractory to medical therapy. During V-A ECMO, retrograde flow in the aorta towards the left ventricle (LV) causes increased left-sided filling pressures, which may lead to pulmonary edema. Different strategies have been proposed to decompress the left heart, including placement of an intraaortic balloon pump (IABP), Impella® (Abiomed), or TandemHeart® (Cardiac Assist). Percutaneous decompression of the left atrium via placement of a transseptal cannula incorporated into the existing venous limb had also been previously done. We describe the novel use of the VFEM venous femoral cannula …
Early Unloading In Venoarterial Extracorporeal Membrane Oxygenation Shock: When, How, Where, And Why?, Benedikt Schrage
Early Unloading In Venoarterial Extracorporeal Membrane Oxygenation Shock: When, How, Where, And Why?, Benedikt Schrage
Journal of Shock and Hemodynamics
As extracorporeal membrane oxygenation increases the left ventricular afterload, a successful treatment plan should include strategies to address this issue. One promising approach to do so is the addition of a second device for active left ventricular unloading. However, this relatively new approach is currently only based on retrospective data. This article summarizes the current perspectives on this approach, provides recommendations for its application, and highlights the need for randomized data on this topic.