Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation
Background: Although extracorporeal life support (ECLS) can provide emergency systemic perfusion for acute fulminant myocarditis (AFM), the mortality rate remains extremely high, especially in those undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist device (...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Journal of the Formosan Medical Association |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664622000389 |
| _version_ | 1828145037647544320 |
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| author | Ying-Hsiang Wang Chien-Sung Tsai Jia-Lin Chen Yi-Ting Tsai Chih-Yuan Lin Hsiang-Yu Yang Po-Shun Hsu |
| author_facet | Ying-Hsiang Wang Chien-Sung Tsai Jia-Lin Chen Yi-Ting Tsai Chih-Yuan Lin Hsiang-Yu Yang Po-Shun Hsu |
| author_sort | Ying-Hsiang Wang |
| collection | DOAJ |
| description | Background: Although extracorporeal life support (ECLS) can provide emergency systemic perfusion for acute fulminant myocarditis (AFM), the mortality rate remains extremely high, especially in those undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist device (VAD) can provide a more physiological blood flow direction and better subsequent organ perfusion than ECLS. We investigated temporary VAD efficacy in ECPR-revived AFM patients. Methods: During January 2012–May 2019, we retrospectively recruited 22 AFM patients with hemodynamic collapse and ECPR; 11 underwent ECLS only and 11 underwent additional VAD support after ECLS. Systemic perfusion was compared via laboratory biochemistry at post-ECPR days 2 (D2) and 4 (D4). Consciousness and cardiac function were assessed through the Glasgow Coma Scale (GCS) and echocardiography, respectively. All major complications and causes of mortality were recorded; 30-day survival was analyzed and risk factors were predicted. Results: The VAD group had significantly better hemodynamic improvement; more inotropes being tapered at D2 and D4; better data representative of systemic perfusion, including albumin, pH, bicarbonate, and lactate levels at D4; and better 30-day survival (72.7% vs. 27.2%, p = 0.033). The causes of mortality included central failure, multiple organ failure, and bacteremia with sepsis. The risk factors included lethal dysrhythmia before ECLS, GCS <5 at D2, and elevated cardiac enzymes at D4. Conclusion: For AFM patients, temporary VAD could provide better systemic perfusion and organ preservation than ECLS. VAD had better survival, including improved recovery and successful transplantation. Hence, temporary VAD should be considered if ECLS cannot revive the sustained cardiogenic shock. |
| first_indexed | 2024-04-11T20:27:11Z |
| format | Article |
| id | doaj.art-769a111f95304beeab32c75f0dbc3edf |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-04-11T20:27:11Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-769a111f95304beeab32c75f0dbc3edf2022-12-22T04:04:38ZengElsevierJournal of the Formosan Medical Association0929-66462022-10-011211019171928Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitationYing-Hsiang Wang0Chien-Sung Tsai1Jia-Lin Chen2Yi-Ting Tsai3Chih-Yuan Lin4Hsiang-Yu Yang5Po-Shun Hsu6Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDepartment of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, TaiwanDivision of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Corresponding author. No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan. Fax: +886 2 87927376Background: Although extracorporeal life support (ECLS) can provide emergency systemic perfusion for acute fulminant myocarditis (AFM), the mortality rate remains extremely high, especially in those undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Temporary ventricular assist device (VAD) can provide a more physiological blood flow direction and better subsequent organ perfusion than ECLS. We investigated temporary VAD efficacy in ECPR-revived AFM patients. Methods: During January 2012–May 2019, we retrospectively recruited 22 AFM patients with hemodynamic collapse and ECPR; 11 underwent ECLS only and 11 underwent additional VAD support after ECLS. Systemic perfusion was compared via laboratory biochemistry at post-ECPR days 2 (D2) and 4 (D4). Consciousness and cardiac function were assessed through the Glasgow Coma Scale (GCS) and echocardiography, respectively. All major complications and causes of mortality were recorded; 30-day survival was analyzed and risk factors were predicted. Results: The VAD group had significantly better hemodynamic improvement; more inotropes being tapered at D2 and D4; better data representative of systemic perfusion, including albumin, pH, bicarbonate, and lactate levels at D4; and better 30-day survival (72.7% vs. 27.2%, p = 0.033). The causes of mortality included central failure, multiple organ failure, and bacteremia with sepsis. The risk factors included lethal dysrhythmia before ECLS, GCS <5 at D2, and elevated cardiac enzymes at D4. Conclusion: For AFM patients, temporary VAD could provide better systemic perfusion and organ preservation than ECLS. VAD had better survival, including improved recovery and successful transplantation. Hence, temporary VAD should be considered if ECLS cannot revive the sustained cardiogenic shock.http://www.sciencedirect.com/science/article/pii/S0929664622000389Cardiogenic shockExtracorporeal life supportExtracorporeal membrane oxygenationFulminant myocarditisVentricular assist device |
| spellingShingle | Ying-Hsiang Wang Chien-Sung Tsai Jia-Lin Chen Yi-Ting Tsai Chih-Yuan Lin Hsiang-Yu Yang Po-Shun Hsu Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation Journal of the Formosan Medical Association Cardiogenic shock Extracorporeal life support Extracorporeal membrane oxygenation Fulminant myocarditis Ventricular assist device |
| title | Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| title_full | Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| title_fullStr | Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| title_full_unstemmed | Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| title_short | Efficacy of a temporary CentriMag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| title_sort | efficacy of a temporary centrimag ventricular assist device in acute fulminant myocarditis patients revived with extracorporeal cardiopulmonary resuscitation |
| topic | Cardiogenic shock Extracorporeal life support Extracorporeal membrane oxygenation Fulminant myocarditis Ventricular assist device |
| url | http://www.sciencedirect.com/science/article/pii/S0929664622000389 |
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