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EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device.

Publication ,  Journal Article
Akanni, OJ; Takeda, K; Truby, LK; Kurlansky, PA; Chiuzan, C; Han, J; Topkara, VK; Yuzefpolskaya, M; Colombo, PC; Karmpaliotis, D; Moses, JW ...
Published in: ASAIO J
2019

Combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a percutaneous microaxial left ventricular assist device (pLVAD), or "EC-VAD," has been reported in cases of left ventricular decompression with mixed results. We conducted a retrospective review of patients who received EC-VAD (n = 29) or isolated VA-ECMO therapy (ECMO-only; n = 196) for refractory cardiogenic shock between February 2011 and October 2014. Fourteen patients received VA-ECMO and then Impella pLVAD (E→EC-VAD), and 15 received the Impella pump then VA-ECMO (I→EC-VAD). E→EC-VAD patients demonstrated decreased pulmonary artery systolic (36.00 ± 16.84 mm Hg versus 30.63 ± 12.13 mm Hg; p = 0.049) and diastolic (24.25 ± 13.45 mm Hg versus 17.25 ± 7.96 mm Hg, p = 0.049) pressures by 24 hours post-EC-VAD implant. In the same period, I→EC-VAD patients demonstrated improved SvO2 (43.14 ± 16.75% versus 75.18 ± 13.88%, p = 0.043) and PaO2/FiO2 ratio (148.55 ± 67.69 mm Hg versus 374.51 ± 170.97 mm Hg, p = 0.043). Thirty-day survival rates were 42.9% in E→EC-VAD, 46.7% in I→EC-VAD, and 49.0% in ECMO-only (p = 0.913). Hemolysis occurred more in EC-VAD patients (44.83% versus 17.35% in ECMO-only, p = 0.002); however, there was no increased frequency of other adverse events including bleeding and lower limb ischemia. Despite increased hemolysis, combined use of VA-ECMO and pLVAD may improve or circumvent left ventricular distension in refractory cardiogenic shock while promoting adequate blood flow.

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Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

2019

Volume

65

Issue

3

Start / End Page

219 / 226

Location

United States

Related Subject Headings

  • Shock, Cardiogenic
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hemolysis
  • Heart-Assist Devices
  • Heart Ventricles
  • Female
  • Extracorporeal Membrane Oxygenation
 

Citation

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Akanni, O. J., Takeda, K., Truby, L. K., Kurlansky, P. A., Chiuzan, C., Han, J., … Takayama, H. (2019). EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device. ASAIO J, 65(3), 219–226. https://doi.org/10.1097/MAT.0000000000000804
Akanni, Olutosin J., Koji Takeda, Lauren K. Truby, Paul A. Kurlansky, Codruta Chiuzan, Jiho Han, Veli K. Topkara, et al. “EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device.ASAIO J 65, no. 3 (2019): 219–26. https://doi.org/10.1097/MAT.0000000000000804.
Akanni OJ, Takeda K, Truby LK, Kurlansky PA, Chiuzan C, Han J, et al. EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device. ASAIO J. 2019;65(3):219–26.
Akanni, Olutosin J., et al. “EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device.ASAIO J, vol. 65, no. 3, 2019, pp. 219–26. Pubmed, doi:10.1097/MAT.0000000000000804.
Akanni OJ, Takeda K, Truby LK, Kurlansky PA, Chiuzan C, Han J, Topkara VK, Yuzefpolskaya M, Colombo PC, Karmpaliotis D, Moses JW, Naka Y, Garan AR, Kirtane AJ, Takayama H. EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous Microaxial Pump Left Ventricular Assist Device. ASAIO J. 2019;65(3):219–226.

Published In

ASAIO J

DOI

EISSN

1538-943X

Publication Date

2019

Volume

65

Issue

3

Start / End Page

219 / 226

Location

United States

Related Subject Headings

  • Shock, Cardiogenic
  • Retrospective Studies
  • Middle Aged
  • Male
  • Humans
  • Hemolysis
  • Heart-Assist Devices
  • Heart Ventricles
  • Female
  • Extracorporeal Membrane Oxygenation