1887
1 - Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference Proceedings
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Acute myocardial infarction is a common cause of cardiogenic shock (approximately 75% of all patients) and out-of-hospital cardiac arrest (approximately 70% of survivors).1 Mechanical hemodynamic support is employed prior to coronary revascularization (pre-percutaneous coronary intervention (PCI)), during or after PCI.2 Revascularization procedure is characterized by a transient interruption of coronary blood flow (due to repetitive contrast dye injections, balloon inflations, atherectomy passes, and stent manipulations) resulting in a negative inotropic effect. Percutaneous left ventricular assist device implantation (Impella and TandemHeart), and intra-aortic balloon pump implantation have been described as strategies to avoid the worsening of cardiac function during PCI in the literature, especially in high-risk patients. The USpella registry has shown that pre-PCI implantation of IMPELLA 2.5 significantly improves survival of cardiogenic shock patients (Figure 1).3

Cardiac arrest is a recognized complication in the cath lab during percutaneous procedures, such as valve interventions, left auricle closure, and vascular interventions in addition to PCI. Extracorporeal cardiopulmonary resuscitation (ECPR) in terms of VA-ECMO plays a role in rescue therapy for cardiac arrest4 with a better outcome, when compared with conventional cardiopulmonary resuscitation (CPR), when CPR is failing.5 However, the technical and logistical possibility to implement ECPR in the cath lab is challenging. First, to deal with an emergency strategy out of intensive care and operative theater. In this context, trained personnel and dedicated sets of instruments and drugs could play a role. Second, the fluoroscope limits the free access to the patient. Moreover, percutaneous VA-ECMO cannulation requires a complex approach as the vascular accesses have been violated in most cases during the procedure. On the other hand, the presence of a multidisciplinary team has to be considered as an important resource.

In conclusion, an adequate cardiac support during cath lab procedures should be planned whenever possible to avoid emergencies especially in high-risk patients. Training and local protocols should be provided to overcome the procedural difficulties of ECPR.

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2017-02-14
2020-09-20
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References

  1. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, 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; 35:37:25412619.
    [Google Scholar]
  2. Muller G, Flecher E, Lebreton G, Luyt CE, Trouillet JL, Bréchot N, Schmidt M, Mastroianni C, Chastre J, Leprince P, Anselmi A, Combes A. 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; 42:3:370378.
    [Google Scholar]
  3. O'Neill WW, Schreiber T, Wohns DH, Rihal C, Naidu SS, Civitello AB, Dixon SR, Massaro JM, Maini B, Ohman EM. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol. 2014; 27::111.
    [Google Scholar]
  4. Soar J, Callaway CW, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, et al.  Part 4: Advanced life support: International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2015; 95::e71e120.
    [Google Scholar]
  5. Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis. Lancet. 2008; 372:9638:554561.
    [Google Scholar]
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  • Article Type: Research Article
Keyword(s): cardiac arrest , cardiogenic shock , cath lab , CPR , ECPR , PCI , revascularization and VA-ECMO
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