Temporary Mechanical Circulatory Support in Cardiogenic Shock Patients After Cardiac Procedures: Selection Algorithm and Weaning Strategies

Overview

Journal Life (Basel)

Specialty Biology

Date 2023 Oct 28

PMID 37895427

Authors

Gaik Nersesian

Sascha Ott

Alexander Fardman

Pia Lanmueller

Daniel Lewin

Alexander Bernhardt

Fabian Emrich

Gloria Faerber

Gabor Szabo

Mehmet Oezkur

Bernd Panholzer

Sebastian V Rojas

Diyar Saeed

Bastian Schmack

Gregor Warnecke

Daniel Zimpfer

Herko Grubitzsch

Volkmar Falk

Evgenij Potapov

Affiliations

Soon will be listed here.

Abstract

Mechanical circulatory support has proven effective in managing postcardiotomy cardiogenic shock by stabilizing patients' hemodynamics and ensuring adequate organ perfusion. Among the available device modalities, the combination of extracorporeal life support and a microaxial flow pump for left ventricular unloading has emerged as a valuable tool in the surgical armamentarium. In this publication, we provide recommendations for the application and weaning of temporary mechanical circulatory support in cardiogenic shock patients, derived from a consensus among leading cardiac centers in German-speaking countries.

Citing Articles

Perioperative Modulation of Left Ventricular Systolic Performance: A Retrospective Study on Ionized Calcium and Vitamin D in Cardiac Surgery Patients.

Stef A, Bodolea C, Bocsan I, Achim A, Tintiuc N, Pop R J Pers Med. 2024; 14(8).

PMID: 39202041 PMC: 11355764. DOI: 10.3390/jpm14080850.

Temporary extracorporeal life support: single-centre experience with a new concept.

Nersesian G, Lewin D, Ott S, Schoenrath F, Hrytsyna Y, Starck C Interdiscip Cardiovasc Thorac Surg. 2024; 38(4).

PMID: 38490254 PMC: 10980585. DOI: 10.1093/icvts/ivae043.

References

Nersesian G, Hennig F, Muller M, Mulzer J, Tsyganenko D, Starck C . Temporary mechanical circulatory support for refractory heart failure: the German Heart Center Berlin experience. Ann Cardiothorac Surg. 2019; 8(1):76-83. PMC: 6379195. DOI: 10.21037/acs.2018.12.01. View

Montagner M, Nersesian G, Eulert-Grehn J, Wert L, Kempfert J, Potapov E . Single arterial access ECMELLA: A new concept and step-by-step procedure. Multimed Man Cardiothorac Surg. 2021; 2021. DOI: 10.1510/mmcts.2021.026. View

Schrage B, Westermann D . Response by Schrage and Westermann to Letters Regarding Article, "Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an.... Circulation. 2021; 143(23):e1024. DOI: 10.1161/CIRCULATIONAHA.121.053992. View

Gass A, Palaniswamy C, Aronow W, Kolte D, Khera S, Ahmad H . Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise. Cardiology. 2014; 129(3):137-43. DOI: 10.1159/000365138. View

Bertoldi L, Pappalardo F, Lubos E, Grahn H, Rybczinski M, Barten M . Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate. J Crit Care. 2020; 57:259-263. DOI: 10.1016/j.jcrc.2019.12.028. View

Potapov E, Starck C, Falk V, Eulert-Grehn J . Mechanical circulatory support: Technical tips for the implantation of a right ventricular assist device. JTCVS Open. 2022; 8:37-40. PMC: 9390364. DOI: 10.1016/j.xjon.2021.09.046. View

Nersesian G, Lewin D, Schoenrath F, Solowjowa N, Kukucka M, Falk V . Percutaneous mitral valve repair assisted by a catheter-based circulatory support device in a heart transplant patient. J Card Surg. 2021; 36(10):3905-3909. DOI: 10.1111/jocs.15802. View

Brasseur A, Scolletta S, Lorusso R, Taccone F . Hybrid extracorporeal membrane oxygenation. J Thorac Dis. 2018; 10(Suppl 5):S707-S715. PMC: 5911562. DOI: 10.21037/jtd.2018.03.84. View

Giunta M, Recchia E, Capuano P, Toscano A, Attisani M, Rinaldi M . Management of harlequin syndrome under ECPELLA support: A report of two cases and a proposed approach. Ann Card Anaesth. 2023; 26(1):97-101. PMC: 9997463. DOI: 10.4103/aca.aca_176_21. View

10.

Hyun J, Kim A, Lee S, Hong J, Kang P, Jung S . Vasoactive-Inotropic Score as a Determinant of Timely Initiation of Venoarterial Extracorporeal Membrane Oxygenation in Patients With Cardiogenic Shock. Circ J. 2021; 86(4):687-694. DOI: 10.1253/circj.CJ-21-0614. View

11.

Eulert-Grehn J, Starck C, Kempfert J, Falk V, Potapov E . ECMELLA 2.0: Single Arterial Access Technique for a Staged Approach in Cardiogenic Shock. Ann Thorac Surg. 2020; 111(2):e135-e137. DOI: 10.1016/j.athoracsur.2020.06.084. View

12.

Fukuhara S, Takeda K, Garan A, Kurlansky P, Hastie J, Naka Y . Contemporary mechanical circulatory support therapy for postcardiotomy shock. Gen Thorac Cardiovasc Surg. 2016; 64(4):183-91. DOI: 10.1007/s11748-016-0625-4. View

13.

Stein L, Silvestry S . Algorithmic management of postcardiotomy shock with mechanical support: Bring a map, a plan, and your parachute-and know how to use all three. JTCVS Open. 2022; 8:55-65. PMC: 9390719. DOI: 10.1016/j.xjon.2021.10.055. View

14.

Orozco-Hernandez E, Ahmed M, Von Meering G, McElwee S, Prejean S, Gongora E . Femoral venoarterial extracorporeal membrane oxygenation using a novel biatrial cannula for venous drainage and left ventricular venting. J Card Surg. 2020; 35(12):3631-3633. DOI: 10.1111/jocs.15087. View

15.

Rissel R, Koelm S, Schepers M, Dohle D, Albers J, Oezkur M . Elevated lactate levels and impaired lactate clearance during extracorporeal life support (ECLS) are associated with poor outcome in cardiac surgery patients. PLoS One. 2022; 17(11):e0278139. PMC: 9704663. DOI: 10.1371/journal.pone.0278139. View

16.

Thiele H, Zeymer U, Thelemann N, Neumann F, Hausleiter J, Abdel-Wahab M . Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial. Circulation. 2018; 139(3):395-403. DOI: 10.1161/CIRCULATIONAHA.118.038201. View

17.

Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan D, Boeken U . 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg. 2020; 161(4):1287-1331. DOI: 10.1016/j.jtcvs.2020.09.045. View

18.

Belletti A, Lerose C, Zangrillo A, Landoni G . Vasoactive-Inotropic Score: Evolution, Clinical Utility, and Pitfalls. J Cardiothorac Vasc Anesth. 2020; 35(10):3067-3077. DOI: 10.1053/j.jvca.2020.09.117. View

19.

Welker C, Huang J, Ramakrishna H . Analysis of the 2020 EACTS/ELSO/STS/AATS Expert Guidelines on the Management of Adult Postcardiotomy Extracorporeal Life Support. J Cardiothorac Vasc Anesth. 2021; 36(7):2207-2219. DOI: 10.1053/j.jvca.2021.06.022. View

20.

Schrage B, Sundermeyer J, Blankenberg S, Colson P, Eckner D, Eden M . Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC Heart Fail. 2023; 11(3):321-330. DOI: 10.1016/j.jchf.2022.11.005. View