PMID- 29734259
OWN - NLM
STAT- MEDLINE
DCOM- 20200309
LR  - 20220408
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 65
IP  - 3
DP  - 2019 Mar/Apr
TI  - EC-VAD: Combined Use of Extracorporeal Membrane Oxygenation and Percutaneous 
      Microaxial Pump Left Ventricular Assist Device.
PG  - 219-226
LID - 10.1097/MAT.0000000000000804 [doi]
AB  - Combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and a 
      percutaneous microaxial left ventricular assist device (pLVAD), or "EC-VAD," has 
      been reported in cases of left ventricular decompression with mixed results. We 
      conducted a retrospective review of patients who received EC-VAD (n = 29) or 
      isolated VA-ECMO therapy (ECMO-only; n = 196) for refractory cardiogenic shock 
      between February 2011 and October 2014. Fourteen patients received VA-ECMO and 
      then Impella pLVAD (E-->EC-VAD), and 15 received the Impella pump then VA-ECMO 
      (I-->EC-VAD). E-->EC-VAD patients demonstrated decreased pulmonary artery systolic 
      (36.00 +/- 16.84 mm Hg versus 30.63 +/- 12.13 mm Hg; p = 0.049) and diastolic 
      (24.25 +/- 13.45 mm Hg versus 17.25 +/- 7.96 mm Hg, p = 0.049) pressures by 24 hours 
      post-EC-VAD implant. In the same period, I-->EC-VAD patients demonstrated improved 
      SvO2 (43.14 +/- 16.75% versus 75.18 +/- 13.88%, p = 0.043) and PaO2/FiO2 ratio 
      (148.55 +/- 67.69 mm Hg versus 374.51 +/- 170.97 mm Hg, p = 0.043). Thirty-day 
      survival rates were 42.9% in E-->EC-VAD, 46.7% in I-->EC-VAD, and 49.0% in ECMO-only 
      (p = 0.913). Hemolysis occurred more in EC-VAD patients (44.83% versus 17.35% in 
      ECMO-only, p = 0.002); however, there was no increased frequency of other adverse 
      events including bleeding and lower limb ischemia. Despite increased hemolysis, 
      combined use of VA-ECMO and pLVAD may improve or circumvent left ventricular 
      distension in refractory cardiogenic shock while promoting adequate blood flow.
FAU - Akanni, Olutosin J
AU  - Akanni OJ
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
FAU - Takeda, Koji
AU  - Takeda K
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
FAU - Truby, Lauren K
AU  - Truby LK
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Kurlansky, Paul A
AU  - Kurlansky PA
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
FAU - Chiuzan, Codruta
AU  - Chiuzan C
AD  - Department of Biostatistics, Mailman School of Public Health, Columbia 
      University, New York, New York.
FAU - Han, Jiho
AU  - Han J
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
FAU - Topkara, Veli K
AU  - Topkara VK
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Yuzefpolskaya, Melana
AU  - Yuzefpolskaya M
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Colombo, Paolo C
AU  - Colombo PC
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Karmpaliotis, Dimitrios
AU  - Karmpaliotis D
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Moses, Jeffery W
AU  - Moses JW
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Naka, Yoshifumi
AU  - Naka Y
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
FAU - Garan, A Reshad
AU  - Garan AR
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Kirtane, Ajay J
AU  - Kirtane AJ
AD  - Department of Medicine, Division of Cardiology, Columbia University Medical 
      Center, New York, New York.
FAU - Takayama, Hiroo
AU  - Takayama H
AD  - From the Department of Surgery, Division of Cardiothoracic Surgery, Columbia 
      University Medical Center, New York, New York.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
SB  - IM
MH  - Aged
MH  - *Combined Modality Therapy
MH  - Extracorporeal Membrane Oxygenation/adverse effects/*methods/mortality
MH  - Female
MH  - Heart Ventricles/physiopathology
MH  - *Heart-Assist Devices/adverse effects
MH  - Hemolysis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/mortality/*therapy
EDAT- 2018/05/08 06:00
MHDA- 2020/03/10 06:00
CRDT- 2018/05/08 06:00
PHST- 2018/05/08 06:00 [pubmed]
PHST- 2020/03/10 06:00 [medline]
PHST- 2018/05/08 06:00 [entrez]
AID - 10.1097/MAT.0000000000000804 [doi]
PST - ppublish
SO  - ASAIO J. 2019 Mar/Apr;65(3):219-226. doi: 10.1097/MAT.0000000000000804.