PMID- 29344963
OWN - NLM
STAT- MEDLINE
DCOM- 20181022
LR  - 20220408
IS  - 1525-1594 (Electronic)
IS  - 0160-564X (Linking)
VI  - 42
IP  - 6
DP  - 2018 Jun
TI  - Refractory Pulmonary Edema and Upper Body Hypoxemia During Veno-Arterial 
      Extracorporeal Membrane Oxygenation-A Case for Atrial Septostomy.
PG  - 664-669
LID - 10.1111/aor.13082 [doi]
AB  - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides mechanical 
      circulatory support for patients with advanced cardiogenic shock, facilitating 
      myocardial recovery and limiting multi-organ failure. In patients with severely 
      limited left ventricular ejection, peripheral VA-ECMO can further increase left 
      ventricular and left atrial pressures (LAP). Failure to decompress the left heart 
      under these circumstances can result in pulmonary edema and upper body hypoxemia, 
      that is, myocardial and cerebral ischemia. Atrial septostomy can decrease LAP in 
      these situations. However, the effects of atrial septostomy on upper body 
      oxygenation remain unknown. After IRB approval, we identified 9 out of 242 adult 
      VA-ECMO patients between January 2011 and June 2016 who also underwent atrial 
      septostomy for refractory pulmonary edema/upper body hypoxemia. We analyzed 
      LAP/pulmonary capillary wedge pressure (PCWP), right atrial pressures (RAPs), 
      P(a) O(2) /F(i) O(2) ratios (blood samples from right radial artery), 
      intrathoracic volume status, and resolution of pulmonary edema before and up to 
      48 h after septostomy. There were no procedure-related complications. Thirty-day 
      survival was 44%. LAP/PCWP decreased by approximately 40% immediately following 
      septostomy and remained so for at least 24 h. P(a) O(2) /F(i) O(2) ratios 
      significantly increased from 0.49 (0.38-2.12) before to 5.35 (3.01-7.69) 
      immediately after septostomy and continued so for 24 h, 6.6 (4.49-10.93). 
      Radiographic measurements also indicated a significant improvement in thoracic 
      intravascular volume status after atrial septostomy. Atrial septostomy reduces 
      LAP and improves upper body oxygenation and intrathoracic vascular volume status 
      in patients developing severe refractory pulmonary edema while undergoing 
      peripheral VA-ECMO. Atrial septostomy therefore appears safe and suitable to 
      reduce the risk of upper body ischemia under these circumstances.
CI  - (c) 2018 International Center for Artificial Organs and Transplantation and Wiley 
      Periodicals, Inc.
FAU - Prasad, Amit
AU  - Prasad A
AD  - Department of Anesthesiology and Perioperative Medicine, Penn State Health, 
      Hershey, PA, USA.
FAU - Ghodsizad, Ali
AU  - Ghodsizad A
AD  - Division of Cardiothoracic Surgery, University of Miami, Miami, FL, USA.
FAU - Brehm, Christoph
AU  - Brehm C
AD  - Heart and Vascular Institute, Penn State Health, Hershey, PA, USA.
FAU - Kozak, Mark
AU  - Kozak M
AD  - Heart and Vascular Institute, Penn State Health, Hershey, PA, USA.
FAU - Korner, Michael
AU  - Korner M
AD  - INTEGRIS Nazih Zuhdi Transplant Institute Baptist Medical Center, Oklahoma City, 
      OK, USA.
FAU - El Banayosy, Aly
AU  - El Banayosy A
AD  - INTEGRIS Nazih Zuhdi Transplant Institute Baptist Medical Center, Oklahoma City, 
      OK, USA.
FAU - Singbartl, Kai
AU  - Singbartl K
AUID- ORCID: 0000-0002-0800-8539
AD  - Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ, USA.
LA  - eng
PT  - Journal Article
DEP - 20180118
PL  - United States
TA  - Artif Organs
JT  - Artificial organs
JID - 7802778
SB  - IM
MH  - Adult
MH  - Extracorporeal Membrane Oxygenation/adverse effects/*methods
MH  - Heart Atria/physiopathology/*surgery
MH  - Humans
MH  - Hypoxia/etiology/physiopathology/*surgery
MH  - Pulmonary Edema/etiology/physiopathology/*surgery
MH  - Shock, Cardiogenic/complications/physiopathology/*surgery
MH  - Survival Analysis
OTO - NOTNLM
OT  - -Atrial septostomy
OT  - -Cardiogenic shock
OT  - -Veno-arterial extracorporeal membrane oxygenation
OT  - Pulmonary edema
EDAT- 2018/01/19 06:00
MHDA- 2018/10/23 06:00
CRDT- 2018/01/19 06:00
PHST- 2017/08/11 00:00 [received]
PHST- 2017/10/09 00:00 [revised]
PHST- 2017/10/24 00:00 [accepted]
PHST- 2018/01/19 06:00 [pubmed]
PHST- 2018/10/23 06:00 [medline]
PHST- 2018/01/19 06:00 [entrez]
AID - 10.1111/aor.13082 [doi]
PST - ppublish
SO  - Artif Organs. 2018 Jun;42(6):664-669. doi: 10.1111/aor.13082. Epub 2018 Jan 18.