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Post Cardiotomy Shock

Federico Pappalardo, Andrea Montisci
Post-cardiotomy cardiogenic shock (PCCS) is a complication of heart surgery associated with a poor prognosis: veno-arterial extracorporeal membrane oxygenation (VA ECMO) ensures end-organ perfusion while fully replacing heart and lung function, though it is associated with unsatisfactory results. Few studies have identified reliable predictors of poor prognosis early in the course of extracorporeal support. A recent study showed the strong prognostic power of urine output in the first 24 hours of VA ECMO in predicting early and late mortality of PCCS...
October 2016: Journal of Thoracic Disease
Nawar Al-Rawas, David Ranney, Lynn McGugan, Marat Fudim, Sade Bell, Annemarie Thompson, Desiree Bonadonna, Mani Daneshmand
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
Maziar Khorsandi, Scott Dougherty, Andrew Sinclair, Keith Buchan, Fiona MacLennan, Omar Bouamra, Philip Curry, Vipin Zamvar, Geoffrey Berg, Nawwar Al-Attar
BACKGROUND: Refractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period...
November 8, 2016: Journal of Cardiothoracic Surgery
Hong Ju Shin, Seunghwan Song, Han Ki Park, Young Hwan Park
BACKGROUND: Survival of children experiencing cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest. METHODS: Patients who were <18 years and underwent ECPR between November 2013 and January 2016 were including in this study. We retrospectively investigated patient medical records. RESULTS: Twelve children, median age 6...
June 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Hsing-Shan Tsai, Yung-Chang Chen, Pao-Hsien Chu
UNLABELLED: Acute kidney injury (AKI) is an important issue in the management of acute cardiovascular diseases. The risk, injury, failure, loss of kidney function, and end-stage renal failure (RIFLE) criteria, and acute kidney injury network (AKIN) criteria have been proposed to stage and predict the outcomes of patients with AKI. In this article, we review AKI in the context of a variety of acute cardiovascular diseases, e.g., acute myocardial infarction (AMI), myocarditis, aortic dissection, and post-cardiotomy cardiogenic shock...
March 2014: Acta Cardiologica Sinica
Maziar Khorsandi, Kasra Shaikhrezai, Sai Prasad, Renzo Pessotto, William Walker, Geoffrey Berg, Vipin Zamvar
BACKGROUND: Post-cardiotomy cardiogenic shock (PCCS) has an incidence of 2-6 % after routine adult cardiac surgery. 0.5-1.5 % are refractory to inotropic and intra-aortic balloon pump (IABP) support. Advanced mechanical circulatory support (AMCS) can be used to salvage carefully selected number of such patients. High costs and major complication rates have lead to centralization and limited funding for such devices in the UK. We have looked the outcomes of such devices in a non-transplant, intermediate-size adult cardiothoracic surgery unit...
2016: Journal of Cardiothoracic Surgery
Hoong Sern Lim
BACKGROUND: Acute decompensated heart failure is the most common acute heart failure phenotype. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide bridging support for patients with acute decompensated heart failure to transplantation. We studied the association between baseline (<6 months), pre-ECMO (<24 h) parameters and outcome of VA-ECMO support in patients with severe acute decompensated heart failure. METHODS: We included 26 consecutive patients with acute decompensated heart failure (acute myocarditis, myocardial infarction or post-cardiotomy shock were excluded) who were bridged with peripheral VA-ECMO to transplantation...
October 9, 2015: European Heart Journal. Acute Cardiovascular Care
N Papadopoulos, S Marinos, A El-Sayed Ahmad, H Keller, P Meybohm, K Zacharowski, A Moritz, A Zierer
OBJECTIVE: Risk factors for adverse outcome after extracorporeal life support (ECLS) are yet to be defined. For this purpose, we reviewed our institutional data from more than a decade, focusing on patients with ECLS. METHODS: Between December 2001 and June 2013, 360 consecutive cardiac surgical patients received ECLS for post-cardiotomy cardiogenic shock, with high mortality risk despite optimal conventional therapy. Patient demographics, clinical characteristics, ECLS-related morbidity, as well as in-hospital and long-term mortality were analysed...
May 2015: Perfusion
Prashant N Mohite, Anton Sabashnikov, Nikhil P Patil, Diana García Sáez, Bartlomiej Zych, Aron F Popov, Alexander Weymann, Thorsten Wahlers, Nandor Marczin, Fabio DeRobertis, Toufan Bahrami, Mohamed Amrani, André R Simon
Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support. The aim of this study was to evaluate factors influencing survival during short-term ventricular assist support in PCCS. In total, 154 CentriMag(®) (Thoratec; CA, USA) devices were implanted for cardiogenic shock between 2004 and 2011 out of which 31 were for PCCS. A retrospective review was performed in 31 PCCS patients who required the CentriMag short-term VAD as a bridge to decision...
September 2014: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Priyadharshanan Ariyaratnam, Lindsay A McLean, Alexander R J Cale, Mahmoud Loubani
Extra-corporeal membrane oxygenation remains the last resort in keeping patients alive in those with profound cardiogenic shock following percutaneous interventions or open surgery on the heart. No guidelines exist on the management of patients on such a device despite a high mortality. We attempt to highlight some universal principles that would be relevant to the current practice of those exposed to this challenging field.
November 2014: Heart Failure Reviews
Erwan Flécher, Amedeo Anselmi, Hervé Corbineau, Thierry Langanay, Jean-Philippe Verhoye, Christian Félix, Guillaume Leurent, Yves Le Tulzo, Yannick Malledant, Alain Leguerrier
OBJECTIVES: To describe the clinical results (both early and at follow-up) of patients currently receiving extracorporeal membrane oxygenation (ECMO) therapy for cardiac and/or pulmonary failure. To assess the effect of indications, clinical presentations and ECMO modalities on early/late clinical outcomes. To identify baseline factors associated with worse survival at follow-up. METHODS: We reviewed the prospectively collected data of 325 patients receiving ECMO therapy at a tertiary referral centre during the 2005-2013 period...
October 2014: European Journal of Cardio-thoracic Surgery
Mohammad Sajjad, Ahmed Osman, Salah Mohsen, Mosleh Alanazi, Murat Ugurlucan, Charles Canver
BACKGROUND: The literature reports conflicting results for survival after extracorporeal membrane oxygenator support, and survival differs in pediatric and adult patients. We present our institutional experience of adult extracorporeal membrane oxygenator support. METHODS: From January 2007 to December 2009, 19 adult patients required extracorporeal membrane oxygenator support after cardiac surgery or catheter interventions. It was provided on an emergency basis to 11 patients, urgently to 5, and electively to 3...
October 2013: Asian Cardiovascular & Thoracic Annals
Bryan G Maxwell, Andrew J Powers, Ahmad Y Sheikh, Peter H U Lee, Robert L Lobato, Jim K Wong
OBJECTIVE: The study objective was to determine whether significant trends over time have occurred in resource use associated with the use of extracorporeal membrane oxygenation in critically ill adults. METHODS: All adult admissions involving extracorporeal membrane oxygenation were examined by using the Nationwide Inpatient Sample database (years 1998-2009). Trends in volume, outcome, and resource use (including hospital charges, length of stay, and charges per day) were analyzed...
August 2014: Journal of Thoracic and Cardiovascular Surgery
Prashant N Mohite, Bartlomiej Zych, Aron F Popov, Anton Sabashnikov, Diana G Sáez, Nikhil P Patil, Mohamed Amrani, Toufan Bahrami, Fabio DeRobertis, Olaf Maunz, Nandor Marczin, Nicholas R Banner, Andre R Simon
OBJECTIVES: Left ventricular assist devices (LVADs) offer very valuable therapeutic options for patients with advanced heart failure. CentriMag (Thoratec, Pleasanton, CA, USA) is an extracorporeal short-term circulatory assist device Conformité Européenne-marked in Europe for use up to 30 days. METHODS: Retrospective analysis of 41 patients with advanced heart failure who, from 2003 to 2011, were supported with CentriMag for >30 days as a bridge to recovery, long-term VAD or transplantation...
November 2013: European Journal of Cardio-thoracic Surgery
Bahaaldin Alsoufi, Vivek Rao, Augustine Tang, Manjula Maganti, Robert Cusimano
BACKGROUND: Post-cardiotomy shock (PCS) has a complex etiology. Although treatment with inotrops and intra-aortic balloon pump (IABP) support improves cardiac performance, end-organ injuries are common and lead to prolonged ICU stay, extended hospitalization and increased mortality. Early consideration of mechanical circulatory support may prevent such complications and improve outcome. METHODS: Between January 1997 and January 2002, 321 patients required IABP and inotropic support for PCS following coronary artery bypass grafting (CABG) at our institution...
April 2012: Journal of the Saudi Heart Association
Matthew P Thomas, Ashley Altman, George J Magovern, Robert J Moraca
BACKGROUND: Post-cardiotomy cardiogenic shock is an infrequent devastating complication with few options for support. MATERIALS AND METHODS: We present a case highlighting use of the Impella 5.0 (ABIOMED; Danvers, MA) for postcardiotomy cardiogenic shock after coronary artery bypass and bioprosthetic aortic valve replacement. RESULTS: Support was maintained for 7 days before being successfully weaned with myocardial recovery and no damage to the bioprosthetic aortic valve...
July 2013: Journal of Cardiac Surgery
Hiroo Takayama, Lauren Truby, Michael Koekort, Nir Uriel, Paolo Colombo, Donna M Mancini, Ulrich P Jorde, Yoshifumi Naka
BACKGROUND: Mortality for refractory cardiogenic shock (RCS) remains high. However, with improving mechanical circulatory support device (MCSD) technology, the treatment options for RCS patients are expanding. We report on a recent 5-year single-center experience with MCSD for treatment of RCS. METHODS: This study was a retrospective review of adult patients who required an MCSD due to RCS in the past 5 years. We excluded those patients with post-cardiotomy shock and post-transplant cardiac graft dysfunction...
January 2013: Journal of Heart and Lung Transplantation
(no author information available yet)
OBJECTIVE: The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of using implantable ventricular assist devices in the treatment of end-stage heart failure. HEART FAILURE: Heart failure is a complex syndrome that impairs the ability of the heart to maintain adequate blood circulation, resulting in multiorgan abnormalities and, eventually, death. In the period of 1994 to 1997, 38,702 individuals in Ontario had a first hospital admission for heart failure...
2004: Ontario Health Technology Assessment Series
Wei-Wen Chang, Feng-Chun Tsai, Tsung-Yu Tsai, Chih-Hsiang Chang, Chang-Chyi Jenq, Ming-Yang Chang, Ya-Chung Tian, Cheng-Chieh Hung, Ji-Tseng Fang, Chih-Wei Yang, Yung-Chang Chen
PURPOSE: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients, such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. This study compares the predictive value of Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Organ System Failure (OSF) obtained on the first day of ECMO removal, and the Acute Kidney Injury Network (AKIN) stages obtained at 48 hours post-ECMO removal (AKIN(48-hour)) in terms of hospital mortality for critically ill patients...
2012: PloS One
Amit Agrawal, Vishal K Singh, Amit Varma, Rajesh Sharma
CONTEXT: Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children. OBJECTIVE: To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin. DATA SOURCE: MEDLINE search (1966-September 2011) using terms vasopressin, terlipressin, arginine-vasopressin, shock, septic shock, vasodilatory shock, cardiac arrest, and resuscitation for reports on vasopressin/terlipressin use in children and manual review of article bibliographies...
April 2012: Indian Pediatrics
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