Catastrophic Bone Cement Implantation Syndrome Treated with Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.
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ABSTRACT:
SUBMITTER: Valiton V
PROVIDER: S-EPMC8883139 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
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Catastrophic Bone Cement Implantation Syndrome Treated with Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.
Valiton Valérian V Giannakopoulos Georgios G Müller Hajo H
CASE (Philadelphia, Pa.) 20211130 1
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Project description:BackgroundCardiac tamponade may present with very different signs and clinical consequences in patients who are supported with venoarterial extracorporeal membrane oxygenation. Failure to recognize cardiac tamponade in this setting can cause failure to wean from venoarterial extracorporeal membrane oxygenation, and even lead to death.Case presentationWe present a 44-year-old Caucasian female in whom cardiac tamponade manifested as venoarterial extracorporeal membrane oxygenation weaning failure. After discovering the contribution of cardiac tamponade, it was possible to wean the patient from venoarterial extracorporeal membrane oxygenation support. No clear signs of cardiac tamponade had existed beforehand.ConclusionsThe diagnosis of cardiac tamponade can be very challenging in venoarterial extracorporeal membrane oxygenation supported patients due to (patho)physiological particularities related to the parallel blood flow.
| S-EPMC9909901 | biostudies-literature
Project description:Cardiogenic shock and cardiac arrest contribute pre-dominantly to mortality in acute cardiovascular care. Here, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has emerged as an established therapeutic option for patients suffering from these life-threatening entities. VA-ECMO provides temporary circulatory support until causative treatments are effective and enables recovery or serves as a bridging strategy to surgical ventricular assist devices, heart transplantation or decision-making. However, in-hospital mortality rate in this treatment population is still around 60%. In the recently published ARREST trial, VA-ECMO treatment lowered mortality rate in patients with ongoing cardiac arrest due to therapy refractory ventricular fibrillation compared to standard advanced cardiac life support in selected patients. Whether VA-ECMO can reduce mortality compared to standard of care in cardiogenic shock has to be evaluated in the ongoing prospective randomized studies EURO-SHOCK (NCT03813134) and ECLS-SHOCK (NCT03637205). As an innate drawback of VA-ECMO treatment, the retrograde aortic flow could lead to an elevation of left ventricular (LV) afterload, increase in LV filling pressure, mitral regurgitation, and elevated left atrial pressure. This may compromise myocardial function and recovery, pulmonary hemodynamics-possibly with concomitant pulmonary congestion and even lung failure-and contribute to poor outcomes in a relevant proportion of treated patients. To overcome these detrimental effects, a multitude of venting strategies are currently engaged for both preventive and emergent unloading. This review aims to provide a comprehensive and structured synopsis of existing venting modalities and their specific hemodynamic characteristics. We discuss in detail the available data on outcome categories and complication rates related to the respective venting option.
| S-EPMC10050067 | biostudies-literature
Project description:Venoarterial extracorporeal membrane oxygenation (vaECMO) is a well-established treatment option for severe cardiogenic shock of various etiologies. Although trials have explored weaning strategies, a brief and conclusive overview is lacking. We present the different aspects of weaning and provide an evidence- and experienced-based guide for clinicians managing patients under vaECMO in the preweaning, weaning, and postweaning phases.
| S-EPMC7190048 | biostudies-literature
Project description:Dengue disease is found worldwide and has been spreading exponentially in the past decades. Severe forms affect about 2% of patients, sometimes leading to organ failure. Recent studies have shown that fulminant dengue myocarditis is more common than previously thought, and fatal cases have been reported. The treatment of fulminant dengue myocarditis remains supportive and is very challenging in cases of cardiogenic shock. Here, we describe four cases presenting with fulminant dengue myocarditis treated with extracorporeal membrane oxygenation, among two survived.
| S-EPMC7866364 | biostudies-literature
Project description: Not available
| S-EPMC9390622 | biostudies-literature
Project description:BackgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) can be a rescue therapy for patients in cardiogenic shock or in refractory cardiac arrest. After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients.MethodsAnalysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy.ResultsA total of 231 patients (age 58.6 ± 14.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24 h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (p = 0.034/p = 0.005) and cumulative incidence of in-hospital death (p = 0.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38, p = 0.011) as well as after propensity score matching (OR 0.24, p = 0.037). We found no significant differences between patients with inodilator treatment and those without.ConclusionEarly epinephrine therapy within the first 24 h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.
| S-EPMC6751670 | biostudies-literature
Project description:BackgroundIn sepsis-induced cardiogenic shock, venoarterial extracorporeal membrane oxygenation (VA-ECMO) can improve survival. Simultaneous acute respiratory distress syndrome (ARDS) increases the risk of differential hypoxia (Harlequin syndrome). Due to desaturated blood ejected by the heart, the head becomes blue, whereas the lower body remains oxygenated by VA-ECMO. We report on an unusual cardiac manifestation, leading to electrical storm.Case summaryWe present the clinical case of a 55-year-old man. During a minor viral pneumonia, superinfection led to severe ARDS and sepsis-induced refractory cardiogenic shock. Venoarterial extracorporeal membrane oxygenation support was initiated. In progressive respiratory failure, an electrocardiogram (ECG) revealed the onset of ST-segment elevations mirroring hypoxic coronary perfusion. As the mixing zone of blood from the heart and the VA-ECMO was in the ascending aorta, hypoxia was limited to the heart. Ventricular arrhythmias recurred, until ventricular fibrillation remained refractory to defibrillation. A second return cannula was inserted into the jugular vein, and veno-arteriovenous ECMO (V-AV-ECMO) was established. After the venous return was added to the circuit, ventricular fibrillation was defibrillated and sinus rhythm remained stable. Within an hour, ST-elevations receded. Systolic function recovered to normal within 26 days.DiscussionIn severe sepsis-related cardiogenic shock, cardiac output is likely to recover. Venoarterial extracorporeal membrane oxygenation is a potential bridge to recovery. Apart from textbook knowledge, Harlequin syndrome can exclusively cause coronary ischaemia, leading to ST-segment elevations and electrical storm. ECGs reveal ST-elevations for early detection. Isolated cardiac Harlequin syndrome can be overlooked or misinterpreted as result of coronary artery disease, but needs immediate therapy to save the patient's life (e.g. V-AV-ECMO).
| S-EPMC11839271 | biostudies-literature
Project description:BackgroundCoronary vasospasm is a known cause of transient myocardial ischaemia with non-acute significant occlusive atherosclerotic coronary lesions. Most of them are often effectively managed with oral vasodilators but a few seem to have recurrent episodes despite good adherence to treatment.Case summaryHere, we report a case of a 54-year-old woman with optimal guideline medical treatment due to known coronary vasospasm. During admission, despite several intravenous vasodilators, she presented recurrent severe coronary vasospasm episodes with subsequent cardiac arrests that required venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. After stabilization, oral vasodilators followed by stellate ganglion block and thoracic sympathectomy were done to avoid new episodes.DiscussionThis case reflects a wide range of treatment possibilities for recurrent coronary vasospasm although optimal medical treatment, including circulatory support with VA-ECMO during the hyperacute phase, which provided significant benefit in the context of recurrent witnessed cardiac arrest due to pulseless electrical activity. Long-acting vasodilators (molsidomine, nicorandil), alongside less commonly used treatments (magnesium, fluvastatin), may be useful in patients with refractory vasospasm. Lastly, it seems reasonable to consider transient stellate ganglion ablation and thoracic sympathectomy as the final step of treatment if severe episodes persist. Nevertheless, stronger evidence is needed for the aforementioned strategies.
| S-EPMC11804802 | biostudies-literature
Project description:Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an effective mechanical circulatory support modality that rapidly restores systemic perfusion for circulatory failure in patients. Given the huge increase in VA-ECMO use, its optimal management depends on continuous and discrete hemodynamic monitoring. This article provides an overview of VA-ECMO pathophysiology, and the current state of the art in hemodynamic monitoring in patients with VA-ECMO.
| S-EPMC7333156 | biostudies-literature
Project description:ObjectivesTo evaluate the clinical outcomes and perioperative complications associated with complete percutaneous decannulation of femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) with the MANTA closure device.MethodsThis is a retrospective analysis of a single surgeon consecutive series of 14 patients at a single center who underwent decannulation from VA-ECMO, 10 of whom underwent a percutaneous method of femoral cannula removal.ResultsAfter a mean duration of VA-ECMO support of 7.4 ± 3.8 days, all 10 patients, with arterial cannulas ranging in size from 17 to 21 Fr, underwent percutaneous decannulation with the MANTA closure device, with immediate hemostasis. One patient had acute lower limb ischemia that was recognized intraoperatively and successfully treated with suction embolectomy. Two patients had a pseudoaneurysm at the distal perfusion catheter site recognized on perioperative imaging studies, one resolving with observation and the other necessitating thrombin injection. One patient had a hematoma that resolved with observation.ConclusionsPercutaneous decannulation from VA-ECMO using the MANTA large-bore vascular closure device is feasible and results in immediate hemostasis with excellent angiographic results.
| S-EPMC8300481 | biostudies-literature