1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 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
2019-08-22
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References

  1. [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 : 2541– 2619 .
    [Google Scholar]
  2. [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 : 370– 378 .
    [Google Scholar]
  3. [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: : 1– 11 .
    [Google Scholar]
  4. [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: : e71– e120 .
    [Google Scholar]
  5. [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 : 554– 561 .
    [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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