Key result
Percutaneous ECMO support successfully reversed multi-organ injury in less than one week, allowing a 65-year-old male in cardiogenic shock to safely undergo HeartMate II LVAD implantation.
Why the study?
Does percutaneous ECMO support improve organ function and allow for safe LVAD implantation in a patient with cardiogenic shock and multi-organ failure?
Case Report (n=1)
Does percutaneous ECMO support improve organ function and allow for safe LVAD implantation in a patient with cardiogenic shock and multi-organ failure?
Percutaneous ECMO can serve as an effective 'bridge to bridge' strategy to reverse multi-organ failure and facilitate safer LVAD implantation in patients with severe cardiogenic shock.
May support percutaneous ECMO as bridge-to-bridge in cardiogenic shock; hypothesis-generating and requires prospective validation before practice change.
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.
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Fitzgerald et al. (2010) conducted a case report in Cardiogenic shock and ischemic cardiomyopathy (n=1). Percutaneous extracorporeal membrane oxygenation (ECMO) was evaluated on Organ resuscitation and successful LVAD implantation. Percutaneous ECMO support successfully reversed multi-organ injury in less than one week, allowing a 65-year-old male in cardiogenic shock to safely undergo HeartMate II LVAD implantation.
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