Key result
Sequential awake VA-ECMO and LVAD successfully bridges post-infarction LV free wall rupture to transplant candidacy.
Why the study?
Refractory cardiogenic shock due to acute myocardial infarction often lacks myocardial recovery despite treatment, making heart transplantation the ultimate option and necessitating optimal collaborative strategies involving ECMO and LVAD as bridges.
Case Report (n=1)
Yes
May support staged awake VA-ECMO then LVAD in select refractory cases; hypothesis-generating and requires prospective validation.
AIM: To highlight an optimal collaborative strategy of three different levels of specialized care cardiac centres. BACKGROUND: Refractory cardiogenic shock is a life-threatening condition. A myocardial recovery is not achieved in many cases despite all efforts and subsequently the heart transplantation remains an ultimate option. Thereby, the use of extracorporeal membrane oxygenation (ECMO) followed by a ventricular assist device in staged bridging provides an attractive approach. CASE REPORT: We report on an optimal cooperation of PCI (percutaneous coronary intervention) centre with ELSO (extracorporeal life support organization) centre and transplant centre in a patient suffering from refractory cardiogenic shock due to acute myocardial infarction (RCSMI) complicated by left ventricle free wall rupture with pericardial tamponade. CONCLUSION: The interhospital collaboration can be essential in the context of patients with RCSMI. The use of ECMO enables safe interhospital transport and gains time for further diagnostic and therapeutic steps in such critically ill patients.
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Kacer et al. (2015) conducted a case report in Refractory cardiogenic shock complicating acute ST-elevation myocardial infarction (n=1). Awake VA-ECMO and LVAD was evaluated on Survival to hospital discharge and heart transplant candidacy. Sequential treatment with awake VA-ECMO and a left ventricular assist device successfully bridged a patient with refractory cardiogenic shock and LV free wall rupture to heart transplant candidacy.
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