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Open Access 01-02-2018 | Review Article

Extracorporeal life support in cardiogenic shock: indications and management in current practice

Authors: C. L. Meuwese, F. Z. Ramjankhan, S. A. Braithwaite, N. de Jonge, M. de Jong, M. P. Buijsrogge, J. G. D. Janssen, C. Klöpping, J. H. Kirkels, D. W. Donker

Published in: Netherlands Heart Journal | Issue 2/2018

Abstract

Veno-arterial extracorporeal life support (VA-ECLS) provides circulatory and respiratory stabilisation in patients with severe refractory cardiogenic shock. Although randomised controlled trials are lacking, the use of VA-ECLS is increasing and observational studies repeatedly have shown treatment benefits in well-selected patients. Current clinical challenges in VA-ECLS relate to optimal management of the individual patient on extracorporeal support given its inherent complexity. In this review article we will discuss indications, daily clinical management and complications of VA-ECLS in cardiogenic shock refractory to conventional treatment strategies.

Kar B, Gregoric ID, Basra SS, et al. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 2011;57:688–96.CrossRefPubMed

Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975–2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009;119:1211–9.CrossRefPubMedPubMedCentral

Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation. 2008;117:686–97.CrossRefPubMed

Engelfriet PM, Poos MJJC, Rutten FH. Netherlands institute for health services research (NIVEL). Last updated: 01.2018. https://www.volksgezondheidenzorg.info/onderwerp/hartfalen/cijfers-context/huidige-situatie#node-prevalentie-van-hartfalen-de-huisartsenpraktijk. Accessed Sept 2016.

Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–96.CrossRefPubMed

Unverzagt S, Buerke M, de Waha A, et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD007398.pub3.PubMed

Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541–619.CrossRefPubMed

Karagiannidis C, Brodie D, Strassmann S, et al. Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016;42:889–96.CrossRefPubMed

Tramm R, Ilic D, Davies AR, Pellegrino VA, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev. 2015; https://doi.org/10.1002/14651858.CD010381.pub2.PubMed

10.

Ouweneel DM, Schotborgh JV, Limpens J, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016;42:1922–34.CrossRefPubMedPubMedCentral

11.

Pranikoff T, Hirschl RB, Remenapp R, et al. Venovenous extracorporeal life support via percutaneous cannulation in 94 patients. Chest. 1999;115:818–22.CrossRefPubMed

12.

Platts DG, Sedgwick JF, Burstow DJ, et al. The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr. 2012;25:131–41.CrossRefPubMed

13.

Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;62:e147–e239.CrossRefPubMed

14.

Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35:156–67.CrossRefPubMed

15.

Riebandt J, Haberl T, Mahr S, et al. Preoperative patient optimization using extracorporeal life support improves outcomes of INTERMACS Level I patients receiving a permanent ventricular assist device. Eur J Cardiothorac Surg. 2014;46:486–92.CrossRefPubMed

16.

Reyentovich A, Barghash MH, Hochman JS. Management of refractory cardiogenic shock. Nat Rev Cardiol. 2016;13:481–92.CrossRefPubMed

17.

Hochman JS, Buller CE, Sleeper LA, et al. Cardiogenic shock complicating acute myocardial infarction—etiologies, management and outcome: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shocK? J Am Coll Cardiol. 2000;36(3 Suppl A):1063–70.CrossRefPubMed

18.

Harjola VP, Lassus J, Sionis A, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015;17:501–9.CrossRefPubMed

19.

Shin TG, Jo IJ, Sim MS, et al. Two-year survival and neurological outcome of in-hospital cardiac arrest patients rescued by extracorporeal cardiopulmonary resuscitation. Int J Cardiol. 2013;168:3424–30.CrossRefPubMed

20.

Maekawa K, Tanno K, Hase M, et al. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med. 2013;41:1186–96.CrossRefPubMed

21.

Ariyaratnam P, McLean LA, Cale AR, et al. Extra-corporeal membrane oxygenation for the post-cardiotomy patient. Heart Fail Rev. 2014;19:717–25.CrossRefPubMed

22.

Delnoij TS, Accord RE, Weerwind PW, et al. Atrial trans-septal thrombus in massive pulmonary embolism salvaged by prolonged extracorporeal life support after thrombo-embolectomy. A bridge to right-sided cardiovascular adaptation. Acute Card Care. 2012;14:138–40.CrossRefPubMed

23.

Brechot N, Luyt CE, Schmidt M, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013;41:1616–26.CrossRefPubMed

24.

Truhlar A, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2015: section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148–201.CrossRefPubMed

25.

de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol. 2013;51:385–93.CrossRef

26.

Bosarge PL, Raff LA, McGwin G Jr., et al. Early initiation of extracorporeal membrane oxygenation improves survival in adult trauma patients with severe adult respiratory distress syndrome. J Trauma Acute Care Surg. 2016;81:236–43.CrossRefPubMed

27.

Thiagarajan RR, Barbaro RP, Rycus PT, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63:60–7.CrossRefPubMed

28.

Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 2015;36:2246–56.CrossRefPubMed

29.

Muller G, Flecher E, Lebreton G, et al. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016;42:370–8.CrossRefPubMed

30.

Kirklin JK, Naftel DC, Kormos RL, et al. The fourth INTERMACS annual report: 4,000 implants and counting. J Heart Lung Transplant. 2012;31:117–26.CrossRefPubMed

31.

Rupprecht L, Lunz D, Philipp A, Lubnow M, Schmid C. Pitfalls in percutaneous ECMO cannulation. Heart Lung Vessel. 2015;7:320–6.PubMedPubMedCentral

32.

Hall AP, Delnoij TS, Donker DW. Extracorporeal cardiopulmonary resuscitation for refractory ventricular fibrillation. A rescue bridge to reperfusion. Acta Anaesthesiol Belg. 2014;65:175–8.PubMed

33.

Boulate D, Luyt CE, Pozzi M, et al. Acute lung injury after mechanical circulatory support implantation in patients on extracorporeal life support: an unrecognized problem. Eur J Cardiothorac Surg. 2013;44:544–9. discussion 549–550.CrossRefPubMed

34.

Rastan AJ, Lachmann N, Walther T, et al. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs. 2006;29:1121–31.CrossRefPubMed

35.

Cooper E, Burns J, Retter A, et al. Prevalence of venous thrombosis following venovenous extracorporeal membrane oxygenation in patients with severe respiratory failure. Crit Care Med. 2015;43:e581–4.CrossRefPubMed

36.

Moubarak G, Weiss N, Leprince P, Luyt CE. Massive intraventricular thrombus complicating extracorporeal membrane oxygenation support. Can J Cardiol. 2008;24(1):e1.CrossRefPubMedPubMedCentral

37.

Heilmann C, Geisen U, Beyersdorf F, et al. Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med. 2012;38:62–8.CrossRefPubMed

38.

Glick D, Dzierba AL, Abrams D, et al. Clinically suspected heparin-induced thrombocytopenia during extracorporeal membrane oxygenation. J Crit Care. 2015;30:1190–4.CrossRefPubMed

39.

Laverdure F, Louvain-Quintard V, Kortchinsky T, et al. PF4-heparin antibodies during ECMO: incidence, course, and outcomes. Intensive Care Med. 2016;42:1082–3.CrossRefPubMed

40.

Lorusso R, Taccone FS, Belliato M, et al. Brain monitoring in adult and pediatric ECMO patients: the importance of early and late assessments. Anaesth Minerva. 2017;83(10):1061–74.

41.

Kuehn C, Orszag P, Burgwitz K, et al. Microbial adhesion on membrane oxygenators in patients requiring extracorporeal life support detected by a universal rDNA PCR test. ASAIO J. 2013;59:368–73.CrossRefPubMed

42.

Shekar K, Roberts JA, McDonald CI, et al. Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study. Crit Care. 2015;19:164.CrossRefPubMedPubMedCentral

43.

Antonucci E, Lamanna I, Fagnoul D, Vincent JL, De Backer D, Silvio Taccone F. The impact of renal failure and renal replacement therapy on outcome during extracorporeal membrane oxygenation therapy. Artif Organs. 2016;40:746–54.CrossRefPubMed

44.

Cheng R, Hachamovitch R, Makkar R, et al. Lack of survival benefit found with use of Intraaortic balloon pump in extracorporeal membrane oxygenation: a pooled experience of 1517 patients. J Invasive Cardiol. 2015;27:453–8.PubMed

45.

Petroni T, Harrois A, Amour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Crit Care Med. 2014;42:2075–82.CrossRefPubMed

46.

Rupprecht L, Florchinger B, Schopka S, et al. Cardiac decompression on extracorporeal life support: a review and discussion of the literature. ASAIO J. 2013;59:547–53.CrossRefPubMed

47.

Meani P, Gelsomino S, Natour E, et al. Modalities and effects of left ventricle unloading on extracorporeal life support: a review of the current literature. Eur J Heart Fail. 2017;19(Suppl 2):84–91.CrossRefPubMed

48.

Aissaoui N, Luyt CE, Leprince P, et al. Predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 2011;37:1738–45.CrossRefPubMed

49.

Luyt CE, Landivier A, Leprince P, et al. Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care. 2012;27:524.e7–524.e14.CrossRef

50.

Aissaoui N, Guerot E, Combes A, et al. Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support. J Am Soc Echocardiogr. 2012;25:632–40.CrossRefPubMed

51.

Ghodsizad A, Koerner MM, Brehm CE, El-Banayosy A. The role of extracorporeal membrane oxygenation circulatory support in the ‘crash and burn’ patient: from implantation to weaning. Curr Opin Cardiol. 2014;29:275–80.CrossRefPubMed

52.

Brugts JJ, Manintveld O, Constantinescu A, et al. Preventing LVAD implantation by early short-term mechanical support and prolonged inodilator therapy: a case series with acute refractory cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation and optimised medical strategy. Neth Heart J. 2014;22:176–81.CrossRefPubMedPubMedCentral

53.

van Houte J, Donker DW, Wagenaar LJ, Slootweg AP, Kirkels JH, van Dijk D. Non-intubated recovery from refractory cardiogenic shock on percutaneous VA-extracorporeal membrane oxygenation. Neth Heart J. 2015;23:386–8.CrossRefPubMedPubMedCentral

Title: Extracorporeal life support in cardiogenic shock: indications and management in current practice
Authors: C. L. Meuwese
F. Z. Ramjankhan
S. A. Braithwaite
N. de Jonge
M. de Jong
M. P. Buijsrogge
J. G. D. Janssen
C. Klöpping
J. H. Kirkels
D. W. Donker
Publication date: 01-02-2018
Publisher: Bohn Stafleu van Loghum
Published in: Netherlands Heart Journal / Issue 2/2018
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI: https://doi.org/10.1007/s12471-018-1073-9

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