PMID- 35949567
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220813
IS  - 1878-5409 (Electronic)
IS  - 1878-5409 (Linking)
VI  - 26
IP  - 2
DP  - 2022 Aug
TI  - Inhaled nitric oxide for ECPELLA management in fulminant myocarditis complicated 
      with severe right ventricular dysfunction: A case report.
PG  - 104-107
LID - 10.1016/j.jccase.2022.03.013 [doi]
AB  - Combination therapy with venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) and Impella (ECPELLA) has been known to be a favorable strategy of 
      mechanical circulation support for patients with fatal cardiogenic shock. 
      However, the practical strategy for weaning ECPELLA in patients with right 
      ventricular (RV) dysfunction remains unclear. We describe a case of a 63-year-old 
      male with fulminant myocarditis presenting with cardiogenic shock who required 
      ECPELLA to improve hemodynamics. Because of persistent severe RV dysfunction 
      despite the introduction of intravenous dobutamine and milrinone, VA-ECMO could 
      not be weaned. Inhaled nitric oxide (iNO) was introduced at 20 ppm to reduce RV 
      afterload, resulting in increased cardiac output (from 1.6 to 5.5 L/min) and 
      ameliorated RV performance (the pulmonary artery pulsatility index was from 0.47 
      to 1.11). Subsequently, VA-ECMO could be weaned. iNO, a selective pulmonary 
      vasodilator, reduces pulmonary vascular resistance, resulting in reduced RV 
      afterload. This is the first case of iNO usage for the management of cardiogenic 
      shock supported by ECPELLA. iNO could be a favorable strategy in ECPELLA patients 
      with refractory RV dysfunction for weaning VA-ECMO through bridging to recovery. 
      LEARNING OBJECTIVE: The practical strategy for weaning venoarterial 
      extracorporeal membrane oxygenation and Impella (ECPELLA) in patients with 
      concomitant right ventricular dysfunction remains unclear. Inhaled nitric oxygen 
      is a novel weaning strategy for patients with biventricular dysfunction supported 
      by ECPELLA. If the response of inhaled nitric oxygen was insufficient under 
      ECPELLA support, implantable ventricular assist devices or transplantation should 
      be considered.
CI  - (c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights 
      reserved. All rights reserved.
FAU - Oki, Takumi
AU  - Oki T
AD  - Department of Cardiovascular Medicine, Kitasato University School of Medicine, 
      Sagamihara, Kanagawa, Japan.
FAU - Ikeda, Yuki
AU  - Ikeda Y
AD  - Department of Cardiovascular Medicine, Kitasato University School of Medicine, 
      Sagamihara, Kanagawa, Japan.
FAU - Ishii, Shunsuke
AU  - Ishii S
AD  - Department of Cardiovascular Medicine, Kitasato University School of Medicine, 
      Sagamihara, Kanagawa, Japan.
FAU - Ako, Junya
AU  - Ako J
AD  - Department of Cardiovascular Medicine, Kitasato University School of Medicine, 
      Sagamihara, Kanagawa, Japan.
LA  - eng
PT  - Case Reports
DEP - 20220422
PL  - Japan
TA  - J Cardiol Cases
JT  - Journal of cardiology cases
JID - 101549579
PMC - PMC9352424
OTO - NOTNLM
OT  - Case report
OT  - Fulminant myocarditis
OT  - Impella
OT  - Inhaled nitric oxide
OT  - Venoarterial extracorporeal membrane oxygenation
COIS- None declared.
EDAT- 2022/08/12 06:00
MHDA- 2022/08/12 06:01
PMCR- 2022/04/22
CRDT- 2022/08/11 02:18
PHST- 2021/10/29 00:00 [received]
PHST- 2022/02/21 00:00 [revised]
PHST- 2022/03/16 00:00 [accepted]
PHST- 2022/08/11 02:18 [entrez]
PHST- 2022/08/12 06:00 [pubmed]
PHST- 2022/08/12 06:01 [medline]
PHST- 2022/04/22 00:00 [pmc-release]
AID - S1878-5409(22)00062-7 [pii]
AID - 10.1016/j.jccase.2022.03.013 [doi]
PST - epublish
SO  - J Cardiol Cases. 2022 Apr 22;26(2):104-107. doi: 10.1016/j.jccase.2022.03.013. 
      eCollection 2022 Aug.