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Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.

Weymann A, Schmack B, Sabashnikov A, Bowles CT, Raake P, Arif R, Verch M, Tochtermann U, Roggenbach J, Popov AF, Simon AR, Karck M, Ruhparwar A - J Cardiothorac Surg (2014)

Bottom Line: All patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%).The cumulative ICU stay was 23.1 ± 9.6 days.The length of support was 8.0 ± 4.3 days (range 3-17 days).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, UB9 6JH London, UK. weymann.alexander@googlemail.com.

ABSTRACT

Background: The purpose of this prospective study was to evaluate the effects and functional outcome of central extracorporeal life support (ECLS) with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.

Methods: Between August 2010 and August 2013, 12 consecutive patients (2 female) with a mean age of 31.6 ± 15.1 years received central ECLS with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. Underlying disease was acute cardiac decompensation due to dilated cardiomyopathy (n = 3, 25%), coronary artery disease with acute myocardial infarction (AMI) (n = 3, 25%), and acute myocarditis (n = 6, 50%). We routinely implemented ECLS by cannulating the ascending aorta, right atrium and inserting a left ventricular decompression cannula vent via the right superior pulmonary vein.

Results: All patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%). Seven patients (58.3%) were discharged after a mean hospital stay of 42 ± 11.9 days. The overall survival from ECLS implantation to the end of the study was 58.3%. The cumulative ICU stay was 23.1 ± 9.6 days. The length of support was 8.0 ± 4.3 days (range 3-17 days).

Conclusions: We strongly recommend left ventricular decompression in refractory cardiogenic shock and lung failure to avoid pulmonary edema, left heart distension and facilitate myocardial recovery.

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Related in: MedlinePlus

Setup of the presented circuit on intensive care unit. RA indicates right atrium, LV left ventricle and Ao ascending aorta. The arrows indicate the direction of blood flow. The three-way taps are used for blood sampling to measure pre-pulmonary mixed venous oxygen saturation and post-pulmonary arterial oxygen saturation. Thus, the effectiveness of the circuit can be monitored continuously and accurately.
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Figure 4: Setup of the presented circuit on intensive care unit. RA indicates right atrium, LV left ventricle and Ao ascending aorta. The arrows indicate the direction of blood flow. The three-way taps are used for blood sampling to measure pre-pulmonary mixed venous oxygen saturation and post-pulmonary arterial oxygen saturation. Thus, the effectiveness of the circuit can be monitored continuously and accurately.

Mentions: The targeted extracorporeal support flow was 2.6 L/min/m2 body surface area for all patients. Intra-operative transesophageal echocardiography (TEE) was routinely performed to confirm correct positioning of the cannulas and this technique was repeatedly applied postoperatively to confirm adequate left ventricular decompression. ECLS total blood flow and left heart vent blood flow were monitored continuously using ultrasonic probes (Transonics Inc.) and continous brain oximetry (near-infrared spectroscopy, INVOS™) was monitored during the Intensive Care Unit (ICU) stay. A three-way tap was routinely placed in the proximal venous line and in the left ventricular vent line (Figure 4). This allowed separate blood gas analyses to be performed in each line and assisted in the detection of coronary hypoxia if the left ventricle began to recover.


Central extracorporeal life support with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.

Weymann A, Schmack B, Sabashnikov A, Bowles CT, Raake P, Arif R, Verch M, Tochtermann U, Roggenbach J, Popov AF, Simon AR, Karck M, Ruhparwar A - J Cardiothorac Surg (2014)

Setup of the presented circuit on intensive care unit. RA indicates right atrium, LV left ventricle and Ao ascending aorta. The arrows indicate the direction of blood flow. The three-way taps are used for blood sampling to measure pre-pulmonary mixed venous oxygen saturation and post-pulmonary arterial oxygen saturation. Thus, the effectiveness of the circuit can be monitored continuously and accurately.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3974212&req=5

Figure 4: Setup of the presented circuit on intensive care unit. RA indicates right atrium, LV left ventricle and Ao ascending aorta. The arrows indicate the direction of blood flow. The three-way taps are used for blood sampling to measure pre-pulmonary mixed venous oxygen saturation and post-pulmonary arterial oxygen saturation. Thus, the effectiveness of the circuit can be monitored continuously and accurately.
Mentions: The targeted extracorporeal support flow was 2.6 L/min/m2 body surface area for all patients. Intra-operative transesophageal echocardiography (TEE) was routinely performed to confirm correct positioning of the cannulas and this technique was repeatedly applied postoperatively to confirm adequate left ventricular decompression. ECLS total blood flow and left heart vent blood flow were monitored continuously using ultrasonic probes (Transonics Inc.) and continous brain oximetry (near-infrared spectroscopy, INVOS™) was monitored during the Intensive Care Unit (ICU) stay. A three-way tap was routinely placed in the proximal venous line and in the left ventricular vent line (Figure 4). This allowed separate blood gas analyses to be performed in each line and assisted in the detection of coronary hypoxia if the left ventricle began to recover.

Bottom Line: All patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%).The cumulative ICU stay was 23.1 ± 9.6 days.The length of support was 8.0 ± 4.3 days (range 3-17 days).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiothoracic Transplantation & Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, UB9 6JH London, UK. weymann.alexander@googlemail.com.

ABSTRACT

Background: The purpose of this prospective study was to evaluate the effects and functional outcome of central extracorporeal life support (ECLS) with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure.

Methods: Between August 2010 and August 2013, 12 consecutive patients (2 female) with a mean age of 31.6 ± 15.1 years received central ECLS with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. Underlying disease was acute cardiac decompensation due to dilated cardiomyopathy (n = 3, 25%), coronary artery disease with acute myocardial infarction (AMI) (n = 3, 25%), and acute myocarditis (n = 6, 50%). We routinely implemented ECLS by cannulating the ascending aorta, right atrium and inserting a left ventricular decompression cannula vent via the right superior pulmonary vein.

Results: All patients were successfully bridged to either recovery (n = 3, 25%), long-term biventricular support (n = 6, 50%) or cardiac transplantation (n = 3, 25%). Seven patients (58.3%) were discharged after a mean hospital stay of 42 ± 11.9 days. The overall survival from ECLS implantation to the end of the study was 58.3%. The cumulative ICU stay was 23.1 ± 9.6 days. The length of support was 8.0 ± 4.3 days (range 3-17 days).

Conclusions: We strongly recommend left ventricular decompression in refractory cardiogenic shock and lung failure to avoid pulmonary edema, left heart distension and facilitate myocardial recovery.

Show MeSH
Related in: MedlinePlus