Document Detail


The use of percutaneous ECMO support as a 'bridge to bridge' in heart failure patients: a case report.
MedLine Citation:
PMID:  20634225     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A 65-year-old male with a known history of ischemic cardiomyopathy was admitted to the intensive care unit in cardiogenic shock. Cardiac catheterization revealed bi-ventricular hypokinesis, with an estimated ejection fraction of 15%. Despite moderate inotropic support, the patient's liver enzymes, international normalization ratio (INR), and creatinine became grossly elevated, indicating multi-organ injury from hypoperfusion. Due to the patient's state of shock and probable bleeding complications, a full sternotomy and emergent biventricular assist device insertion was deemed very high risk. In order to achieve hemodynamic stability, a decision was made for extracorporeal membrane oxygenation (ECMO) support. ECMO support was quickly initiated by percutaneous cannulation of the femoral vein and artery. The ECMO circuit was comprised of a Centrimag blood pump and Quadrox-D Safeline-coated membrane oxygenator. With successful perfusion and organ resuscitation, abnormal liver function tests, INR, and creatinine all returned to normal in less than one week. With normal organ function, especially the liver, the patient successfully underwent an implantable left ventricular assist device, HeartMate II LVAD, without requiring mechanical right heart support. Prior to ECMO, the patient was at very high risk of needing biventricular support. Thus, the temporary use of ECMO allowed for a safer and more durable bridge to transplantation. The use of percutaneous ECMO has many advantages, including improving the patient condition and allowing for time to evaluate fully the LVAD patient.
Authors:
David Fitzgerald; Amy Ging; Nelson Burton; Shashank Desai; Tonya Elliott; Lori Edwards
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-07-15
Journal Detail:
Title:  Perfusion     Volume:  25     ISSN:  1477-111X     ISO Abbreviation:  Perfusion     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-23     Completed Date:  2011-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8700166     Medline TA:  Perfusion     Country:  England    
Other Details:
Languages:  eng     Pagination:  321-5, 327     Citation Subset:  IM    
Affiliation:
The INOVA Heart and Vascular Institute, Falls Church, VA, USA. David.Fitzgerald@inova.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Extracorporeal Membrane Oxygenation / instrumentation,  methods*
Heart Catheterization
Heart Failure / therapy*
Heart Transplantation
Humans
Male
Shock, Cardiogenic

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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