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      Additional unloading of the left ventricle using the Impella LP 2.5 during extracorporeal life support in cases of pulmonary congestion

      case-report

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          Abstract

          Extracorporeal life support (ECLS) is used for the treatment of severe cardiogenic shock. However, pulmonary congestion can progress to a severe problem with ECLS therapy. We report our experience with the Impella system for severe pulmonary congestion with ECLS therapy. We used the Impella system for two patients, which led to successful unloading of the left ventricle. Impella implantation during ECLS support appears to be a promising concept. However, more evidence is required for further evaluation.

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          Left ventricular unloading during veno-arterial ECMO: a review of percutaneous and surgical unloading interventions

          Dirk W. Donker, Daniel Brodie, José Henriques … (2018)
          Short-term mechanical support by veno-arterial extracorporeal membrane oxygenation (VA ECMO) is more and more applied in patients with severe cardiogenic shock. A major shortcoming of VA ECMO is its variable, but inherent increase of left ventricular (LV) mechanical load, which may aggravate pulmonary edema and hamper cardiac recovery. In order to mitigate these negative sequelae of VA ECMO, different adjunct LV unloading interventions have gained a broad interest in recent years. Here, we review the whole spectrum of percutaneous and surgical techniques combined with VA ECMO reported to date.
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            Left atrial decompression during venoarterial extracorporeal membrane oxygenation for left ventricular failure in children: current strategy and clinical outcomes.

            Yasuhiro Kotani, Devin Chetan, Warren Rodrigues … (2013)
            From 2005 to 2011, 23 of 178 (12.9%) patients with venoarterial (VA) extracorporeal membrane oxygenation (ECMO) had left atrial (LA) decompression to help improve left ventricular (LV) function, LA/LV dilatation, and/or lung edema. LA decompression was achieved with LA cannulation (n = 16), surgically created adjustable atrial septal defect (n = 3), or balloon atrial septostomy (n = 4). Sixteen (70%) patients had LA decompression at the time of ECMO initiation and all had LA decompression within 12 hours of ECMO initiation. ECMO duration was 5.9 ± 4.5 days and 16 (70%) patients were successfully decannulated. Subsequent intensive care unit and hospital survival was achieved in 13 (57%) and 12 (52%) patients, respectively. Earlier timing of LA decompression appeared to be associated with a high probability of weaning from ECMO and reasonable LV functional recovery.
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              Percutaneous left-heart decompression during extracorporeal membrane oxygenation: an alternative to surgical and transeptal venting in adult patients.

              Leonello Avalli, Elena Maggioni, Fabio Sangalli … (2011)
              Extracorporeal membrane oxygenation (ECMO) is often applied for acute cardiorespiratory failure. Left ventricular distension can compromise recovery of the failing heart. To overcome this complication, we describe a new technique to decompress the left heart through the insertion of a venting cannula in the pulmonary artery. A 43-year-old woman was connected to ECMO for refractory cardiogenic shock after left pneumonia and severe sepsis. Transesophageal echocardiography (TEE) revealed a large intraventricular clot. A 15F venous cannula was placed percutaneously in the pulmonary artery and connected to the venous limb of the ECMO circuit to decompress the left heart, and to prevent left ventricular ejection and potential embolization. After myocardial recovery, when the thrombus was judged as stable, the patient was weaned, and ECMO was removed on day 16. The patient was discharged from the cardiac surgery intensive care unit on day 30 and subsequently had an uneventful recovery. This new percutaneous approach represent a feasible and effective method to vent the left heart during ECMO, when it becomes necessary to reduce wall tension or to prevent ejection.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: November 2018
                Publication date (Electronic): 13 November 2018
                Publication date PMC-release: 13 November 2018
                Volume: 2018
                Issue: 11
                Electronic Location Identifier: rjy302
                Affiliations
                [1 ]Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
                [2 ]Department of Cardiovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany
                [3 ]Department of Cardiology, Angiology and Pneumology, University Hospital Dusseldorf, Dusselfdorf, Germany
                [4 ]Department of Anaesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany
                [5 ]Section of Cardiac and Thoracic Surgery, Department of Surgery, the University of Chicago, Chicago, IL, USA
                Author notes
                Correspondence address. Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan. Tel: +81-166-668-2494; Fax: +81-166-68-2499; E-mail: hayato-ise8810@ 123456asahikawa-med.ac.jp
                Author information
                http://orcid.org/0000-0001-7084-5429
                Article
                Publisher ID: rjy302
                DOI: 10.1093/jscr/rjy302
                PMC ID: 6232276
                PubMed ID: 30443318
                SO-VID: b3311443-9996-44da-b780-20599c738b68
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2018.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                Date received : 27 August 2018
                Date revision received : 15 October 2018
                Date accepted : 24 October 2018
                Page count
                Pages: 4
                Categories
                Subject: Case Report

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