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Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation

Background: The extracorporeal life support (ECLS) and temporary bilateral ventricular assist device (t-BiVAD) are commonly applied in patients with cardiogenic shock. Prolonged cardiopulmonary resuscitation (CPR) has poor prognosis. Herein, we report our findings on a combined ECLS and t-BiVAD appr...

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Autores principales: Chen, Jia-Lin, Tsai, Yi-Ting, Lin, Chih-Yuan, Ke, Hong-Yan, Lin, Yi-Chang, Yang, Hsiang-Yu, Liu, Chien-Ting, Sung, Shih-Ying, Chang, Jui-Tsung, Wang, Ying-Hsiang, Lin, Tso-Chou, Tsai, Chien-Sung, Hsu, Po-Shun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267666/
https://www.ncbi.nlm.nih.gov/pubmed/35807056
http://dx.doi.org/10.3390/jcm11133773
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author Chen, Jia-Lin
Tsai, Yi-Ting
Lin, Chih-Yuan
Ke, Hong-Yan
Lin, Yi-Chang
Yang, Hsiang-Yu
Liu, Chien-Ting
Sung, Shih-Ying
Chang, Jui-Tsung
Wang, Ying-Hsiang
Lin, Tso-Chou
Tsai, Chien-Sung
Hsu, Po-Shun
author_facet Chen, Jia-Lin
Tsai, Yi-Ting
Lin, Chih-Yuan
Ke, Hong-Yan
Lin, Yi-Chang
Yang, Hsiang-Yu
Liu, Chien-Ting
Sung, Shih-Ying
Chang, Jui-Tsung
Wang, Ying-Hsiang
Lin, Tso-Chou
Tsai, Chien-Sung
Hsu, Po-Shun
author_sort Chen, Jia-Lin
collection PubMed
description Background: The extracorporeal life support (ECLS) and temporary bilateral ventricular assist device (t-BiVAD) are commonly applied in patients with cardiogenic shock. Prolonged cardiopulmonary resuscitation (CPR) has poor prognosis. Herein, we report our findings on a combined ECLS and t-BiVAD approach to salvage cardiogenic-shock patients with CPR for more than one hour. Methods: Fifty-nine patients with prolonged CPR and rescued by ECLS and subsequent t-BiVAD were retrospectively collected between January 2015 and December 2019. Primary diagnoses included ischemic, dilated cardiomyopathy, acute myocardial infarction, post-cardiotomy syndrome, and fulminant myocarditis. The mean LVEF was 16.9% ± 6.56% before t-BiVAD. The median ECLS-to-VAD interval is 26 h. Results: A total of 26 patients (44%) survived to weaning, including 13 (22%) bridged to recovery, and 13 (22%) bridged to transplantation. Survivors to discharge demonstrated better systemic perfusion and hemodynamics than non-survivors. The CentriMag-related complications included bleeding (n = 22, 37.2%), thromboembolism (n = 5, 8.4%), and infection (n = 4, 6.7%). The risk factors of mortality included Glasgow Coma Scale (Motor + Eye) ≤ 5, and lactate ≥ 8 mmol/L at POD-1, persistent ventricular rhythm or asystole, and total bilirubin ≥ 6 mg/dL at POD-3. Mortality factors included septic shock (n = 11, 18.6%), central failure (n = 10, 16.9%), and multiple organ failure (n = 12, 20.3%). Conclusions: Combined ECLS and t-BiVAD could be a salvage treatment for patients with severe cardiogenic shock, especially for those already having prolonged CPR. This combination can correct organ malperfusion and allow sufficient time to bridge patients to recovery and heart transplantation, especially in Asia, where donation rates are low, as well as intracorporeal VAD or total artificial heart being seldom available.
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spelling pubmed-92676662022-07-09 Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation Chen, Jia-Lin Tsai, Yi-Ting Lin, Chih-Yuan Ke, Hong-Yan Lin, Yi-Chang Yang, Hsiang-Yu Liu, Chien-Ting Sung, Shih-Ying Chang, Jui-Tsung Wang, Ying-Hsiang Lin, Tso-Chou Tsai, Chien-Sung Hsu, Po-Shun J Clin Med Article Background: The extracorporeal life support (ECLS) and temporary bilateral ventricular assist device (t-BiVAD) are commonly applied in patients with cardiogenic shock. Prolonged cardiopulmonary resuscitation (CPR) has poor prognosis. Herein, we report our findings on a combined ECLS and t-BiVAD approach to salvage cardiogenic-shock patients with CPR for more than one hour. Methods: Fifty-nine patients with prolonged CPR and rescued by ECLS and subsequent t-BiVAD were retrospectively collected between January 2015 and December 2019. Primary diagnoses included ischemic, dilated cardiomyopathy, acute myocardial infarction, post-cardiotomy syndrome, and fulminant myocarditis. The mean LVEF was 16.9% ± 6.56% before t-BiVAD. The median ECLS-to-VAD interval is 26 h. Results: A total of 26 patients (44%) survived to weaning, including 13 (22%) bridged to recovery, and 13 (22%) bridged to transplantation. Survivors to discharge demonstrated better systemic perfusion and hemodynamics than non-survivors. The CentriMag-related complications included bleeding (n = 22, 37.2%), thromboembolism (n = 5, 8.4%), and infection (n = 4, 6.7%). The risk factors of mortality included Glasgow Coma Scale (Motor + Eye) ≤ 5, and lactate ≥ 8 mmol/L at POD-1, persistent ventricular rhythm or asystole, and total bilirubin ≥ 6 mg/dL at POD-3. Mortality factors included septic shock (n = 11, 18.6%), central failure (n = 10, 16.9%), and multiple organ failure (n = 12, 20.3%). Conclusions: Combined ECLS and t-BiVAD could be a salvage treatment for patients with severe cardiogenic shock, especially for those already having prolonged CPR. This combination can correct organ malperfusion and allow sufficient time to bridge patients to recovery and heart transplantation, especially in Asia, where donation rates are low, as well as intracorporeal VAD or total artificial heart being seldom available. MDPI 2022-06-29 /pmc/articles/PMC9267666/ /pubmed/35807056 http://dx.doi.org/10.3390/jcm11133773 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chen, Jia-Lin
Tsai, Yi-Ting
Lin, Chih-Yuan
Ke, Hong-Yan
Lin, Yi-Chang
Yang, Hsiang-Yu
Liu, Chien-Ting
Sung, Shih-Ying
Chang, Jui-Tsung
Wang, Ying-Hsiang
Lin, Tso-Chou
Tsai, Chien-Sung
Hsu, Po-Shun
Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title_full Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title_fullStr Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title_full_unstemmed Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title_short Extracorporeal Life Support and Temporary CentriMag Ventricular Assist Device to Salvage Cardiogenic-Shock Patients Suffering from Prolonged Cardiopulmonary Resuscitation
title_sort extracorporeal life support and temporary centrimag ventricular assist device to salvage cardiogenic-shock patients suffering from prolonged cardiopulmonary resuscitation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267666/
https://www.ncbi.nlm.nih.gov/pubmed/35807056
http://dx.doi.org/10.3390/jcm11133773
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