-
Journal of the American College of... Dec 2015An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure. These... (Review)
Review
An increasing number of devices can provide mechanical circulatory support (MCS) to patients with acute hemodynamic compromise and chronic end-stage heart failure. These devices work by different pumping mechanisms, have various flow capacities, are inserted by different techniques, and have different sites from which blood is withdrawn and returned to the body. These factors result in different primary hemodynamic effects and secondary responses of the body. However, these are not generally taken into account when choosing a device for a particular patient or while managing a patient undergoing MCS. In this review, we discuss fundamental principles of cardiac, vascular, and pump mechanics and illustrate how they provide a broad foundation for understanding the complex interactions between the heart, vasculature, and device, and how they may help guide future research to improve patient outcomes.
Topics: Assisted Circulation; Cardiac Output; Extracorporeal Membrane Oxygenation; Heart Failure; Heart-Assist Devices; Hemodynamics; Humans; Treatment Outcome
PubMed: 26670067
DOI: 10.1016/j.jacc.2015.10.017 -
European Journal of Heart Failure Aug 2016
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of...
Topics: Acute Disease; Assisted Circulation; Cardiac Imaging Techniques; Cardiovascular Agents; Chronic Disease; Heart Failure; Heart Function Tests; Heart Transplantation; Humans; Stroke Volume
PubMed: 27207191
DOI: 10.1002/ejhf.592 -
Sao Paulo Medical Journal = Revista... 2022
Topics: Assisted Circulation; Heart Failure; Humans
PubMed: 35584526
DOI: 10.1590/1516-3180.2022.140303122021 -
Journal of the American College of... Apr 2022Venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases left ventricular (LV) afterload, potentially provoking LV distention and impairing recovery. LV...
BACKGROUND
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) increases left ventricular (LV) afterload, potentially provoking LV distention and impairing recovery. LV mechanical unloading (MU) with intra-aortic balloon pump (IABP) or percutaneous ventricular assist device (pVAD) can prevent LV distension, potentially at the risk of more complications, and net clinical benefit remains uncertain.
OBJECTIVES
This study aims to determine the association between MU and outcomes for patients undergoing VA-ECMO.
METHODS
The authors queried the Extracorporeal Life Support Organization registry for adults receiving peripheral VA-ECMO from 2010 to 2019 and stratified them by MU with IABP or pVAD. The primary outcome was in-hospital mortality; secondary outcomes included on-support mortality and complications during VA-ECMO.
RESULTS
Among 12,734 VA-ECMO patients, 3,399 (26.7%) received MU: 2,782 (82.9%) IABP and 580 (17.1%) pVAD. MU patients were older (age 56.3 vs 52.7 years) and, before extracorporeal membrane oxygenation, more often required >2 vasopressors (41.7% vs 27.2%) and had respiratory (21.1% vs 15.9%), renal (24.6% vs 15.8%), and liver failure (4.4% vs 3.1%) (all P < 0.001). MU patients had lower in-hospital mortality (56.6% vs 59.3%, P = 0.006), which persisted in multivariable modeling (adjusted OR [aOR]: 0.84; 95% CI: 0.77-0.92; P < 0.001). MU was associated with more cannula site bleeding (aOR: 1.25; 95% CI: 1.11-1.40; P < 0.001) and hemolysis (aOR: 1.27; 95% CI: 1.03-1.57; P = 0.02). Compared to pVAD, MU patients with IABP had similar mortality (aOR: 0.80; 95% CI: 0.64-1.01; P = 0.06) and less medical bleeding (aOR: 0.45; 95% CI: 0.31-0.64; P < 0.001), cannula site bleeding (aOR: 0.72; 95% CI: 0.54-0.96; P = 0.03), and renal injury (aOR: 0.78; 95% CI: 0.62-0.98; P = 0.03).
CONCLUSIONS
Among adults receiving VA-ECMO, MU was associated with lower in-hospital mortality despite increased complications including hemolysis and cannulation site bleeding. Compared to pVAD, MU with IABP was associated with similar mortality and lower complication rates.
Topics: Adult; Extracorporeal Membrane Oxygenation; Heart Ventricles; Heart-Assist Devices; Humans; Intra-Aortic Balloon Pumping; Middle Aged; Shock, Cardiogenic
PubMed: 35361346
DOI: 10.1016/j.jacc.2022.01.032 -
The Journal of Invasive Cardiology Jan 2023This clinical image vignette describes the inadvertent placement of a balloon pump in the vena cava during a "code blue" scenario, and the lessons to be learned from...
This clinical image vignette describes the inadvertent placement of a balloon pump in the vena cava during a "code blue" scenario, and the lessons to be learned from that experience. The hemodynamic benefits of intra-aortic balloon pump during experimental cardiac arrest include shorter circulation time and increases in end-tidal CO2 and coronary perfusion pressure. However, the hemodynamic effects of venous diastolic augmentation during experimental cardiogenic shock vary, being detrimental in cases of low preload, and possibly beneficial in a high preload state. When performed emergently at the bedside, inadvertent intra-caval placement of a balloon pump can occur due to elevated venous pressures, in the presence of severe tricuspid regurgitation, or through an arteriovenous fistula. A similar radiographic appearance can also be seen in the presence of a right-sided aortic arch. Clues to improper position include an abnormal pressure waveform and the absence of hemodynamic changes or blood pressure augmentation.
Topics: Humans; Hemodynamics; Shock, Cardiogenic; Intra-Aortic Balloon Pumping; Tricuspid Valve Insufficiency; Heart-Assist Devices
PubMed: 36588096
DOI: No ID Found -
The Journal of Thoracic and... Aug 2018
Topics: Heart; Heart Ventricles; Heart-Assist Devices
PubMed: 29779631
DOI: 10.1016/j.jtcvs.2018.04.027 -
The Journal of Thoracic and... Mar 2017
Topics: Heart-Assist Devices; Hope
PubMed: 28341298
DOI: 10.1016/j.jtcvs.2016.09.059 -
International Heart Journal Nov 2020Veno-arterial extracorporeal membrane oxygenation (ECMO) is a strong mechanical circulatory device for patients with hemodynamic deterioration due to cardiogenic shock,... (Review)
Review
Veno-arterial extracorporeal membrane oxygenation (ECMO) is a strong mechanical circulatory device for patients with hemodynamic deterioration due to cardiogenic shock, but its drawback is an increase in left ventricular afterload. The Impella axial-flow transcatheter left ventricular assist device is a recently developed promising device to mechanically unload the left ventricle, although its support flow may not necessarily be sufficient to support shock vital. Recently, ECMO and concomitant Impella support (ECPELLA) is increasingly being used to treat cardiogenic shock by maintaining systemic circulation and unloading the left ventricle. There are several pitfalls to maintaining ECPELLA, and one useful tool is the pulmonary artery pulsatility index. The clinical advantages of ECPELLA compared to conventional ECMO alone should be demonstrated in larger scale studies in the near future.
Topics: Acidosis; Assisted Circulation; Combined Modality Therapy; Extracorporeal Membrane Oxygenation; Femoral Artery; Heart-Assist Devices; Humans; Hypoxia; Lactic Acid; Pulmonary Artery; Pulsatile Flow; Shock, Cardiogenic; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right
PubMed: 33116023
DOI: 10.1536/ihj.20-172 -
Clinical and Applied... 2021Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on... (Review)
Review
Mechanically assisted circulation (MAC) sustains the blood circulation in the body of a patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) or on ventricular assistance with a ventricular assist device (VAD) or on extracorporeal membrane oxygenation (ECMO) with a pump-oxygenator system. While MAC provides short-term (days to weeks) support and long-term (months to years) for the heart and/or lungs, the blood is inevitably exposed to non-physiological shear stress (NPSS) due to mechanical pumping action and in contact with artificial surfaces. NPSS is well known to cause blood damage and functional alterations of blood cells. In this review, we discussed shear-induced platelet adhesion, platelet aggregation, platelet receptor shedding, and platelet apoptosis, shear-induced acquired von Willebrand syndrome (AVWS), shear-induced hemolysis and microparticle formation during MAC. These alterations are associated with perioperative bleeding and thrombotic events, morbidity and mortality, and quality of life in MCS patients. Understanding the mechanism of shear-induce hemostatic disorders will help us develop low-shear-stress devices and select more effective treatments for better clinical outcomes.
Topics: Animals; Blood Platelets; Cardiopulmonary Bypass; Cell-Derived Microparticles; Extracorporeal Membrane Oxygenation; Heart-Assist Devices; Hemolysis; Hemostatic Disorders; Humans; Oxygenators, Membrane; Platelet Activation; Prosthesis Design; Prosthesis Implantation; Risk Assessment; Risk Factors; Stress, Mechanical; Treatment Outcome
PubMed: 33571008
DOI: 10.1177/1076029620982374 -
JACC. Heart Failure Jul 2022
Topics: Heart Failure; Heart-Assist Devices; Humans; Treatment Outcome
PubMed: 35772858
DOI: 10.1016/j.jchf.2022.05.002