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Temporary extracorporeal life support: single-centre experience with a new concept.
Nersesian, Gaik; Lewin, Daniel; Ott, Sascha; Schoenrath, Felix; Hrytsyna, Yuriy; Starck, Christoph; Spillmann, Frank; O'Brien, Benjamin; Falk, Volkmar; Potapov, Evgenij; Lanmueller, Pia.
Afiliación
  • Nersesian G; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Lewin D; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
  • Ott S; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Schoenrath F; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
  • Hrytsyna Y; Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Starck C; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Spillmann F; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
  • O'Brien B; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Falk V; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
  • Potapov E; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
  • Lanmueller P; Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Interdiscip Cardiovasc Thorac Surg ; 38(4)2024 Mar 29.
Article en En | MEDLINE | ID: mdl-38490254
ABSTRACT

OBJECTIVES:

The combination of veno-arterial extracorporeal membrane oxygenation with a micro-axial flow pump (ECMELLA) is increasingly used for cardiogenic shock (CS) therapy. We report our experience with a novel single-artery access ECMELLA setup with either femoral (2.0) or jugular venous cannulation (2.1), respectively.

METHODS:

Data from 67 consecutive CS patients treated with ECMELLA 2.0 (n = 56) and 2.1 (n = 11) from December 2020 and December 2022 in a tertiary cardiac center were retrospectively analyzed.

RESULTS:

The mean age was 60.7 ± 11 years, 56 patients (84%) were male. CS aetiology was acute on chronic heart failure (n = 35, 52%), myocardial infarction (n = 13, 19.5%), postcardiotomy syndrome (n = 16, 24%) and myocarditis (n = 3, 4.5%). Preoperatively 31 patients (46%) were resuscitated, 53 (79%) were on a ventilator and 60 (90%) were on inotropic support. The median vasoactive inotropic score was 32, and the mean arterial lactate was 8.1 mmol/l. In 39 patients (58%), veno-arterial extracorporeal membrane oxygenation was explanted after a median ECMELLA support of 4 days. Myocardial recovery was achieved in 18 patients (27%), transition to a durable left ventricular assist device in 16 (24%). Thirty-three patients (n = 33; 49%) died on support (25 on ECMELLA and 8 on Impella after de-escalation), 9 (13%) of whom were palliated. Axillary access site bleeding occurred in 9 patients (13.5%), upper limb ischaemia requiring surgical revision in 3 (4.5%). Axillary site infection occurred in 6 cases (9%), and perioperative stroke in 10 (15%; 6 hemorrhagic, 4 thromboembolic).

CONCLUSIONS:

ECMELLA 2.0/2.1 is a feasible and effective therapy for severe CS. The single-artery cannulation technique is associated with a relatively low rate of access-related complications.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Interdiscip Cardiovasc Thorac Surg Año: 2024 Tipo del documento: Article País de afiliación: Alemania Pais de publicación: Reino Unido