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ECMO-Extracorporeal Life Support in Adults pp 151–161Cite as

ECMO for High-Risk Procedures

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Abstract

The impressive progresses of the last few decades have dramatically changed the management of cardiac conditions previously deemed “too high risk”. The use of extracorporeal membrane oxygenation (ECMO) as cardiopulmonary support has paved the way for new operative indications for those patients who were previously relegated to conservative medical management. The combination of a compact pump-oxygenator design, with smaller, percutaneous, flexible cannulae, makes the modern veno-arterial ECMO an ideal miniaturised cardiopulmonary bypass. In this chapter we will discuss the application of VA ECMO support during high-risk procedure such as percutaneous coronary interventions, transcatheter aortic valve implantation, post-infarct ventricular septal defect repair, and as bridge therapy before urgent pulmonary thromboembolectomy.

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References

  1. Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators (2009) Extracorporeal membrane oxygenation for 2009 influenza A (H1N1) acute respiratory distress syndrome. JAMA 302(17):1888–1895

    Article  Google Scholar 

  2. Spina R, Forrest AP, Adams MR, Wilson MK, Ng MK, Vallely MP (2010) Veno-arterial extracorporeal membrane oxygenation for high-risk cardiac catheterisation procedures. Heart Lung Circ 19(12):736–741

    Article  PubMed  Google Scholar 

  3. Vallely MP, Wilson MK, Adams M, Ng MKC (2012) How to set up a successful TAVI program. Ann Cardiothorac Surg 1(2):185–189

    PubMed  PubMed Central  Google Scholar 

  4. Ramponi F, Yan TD, Vallely MP, Wilson MK (2011) Total percutaneous cardiopulmonary bypass with Perclose ProGlide. Interact Cardiovasc Thorac Surg 13(1):86–88

    Article  PubMed  Google Scholar 

  5. Forrest P, Cheong JY, Vallely MP, Torzillo PJ, Hendel PN, Wilson MK, Bannontt PG, Bayfield MS, Herkes R, Walker SW (2011) International retrieval of adults on extracorporeal membrane oxygenation support. Anaesth Intensive Care 39(6):1082–1085

    CAS  PubMed  Google Scholar 

  6. Ramponi F, Wilson MK, Vedelago J, Bayfield MS (2011) Catastrophic pulmonary and paradoxical embolism. ANZ J Surg 81(11):843–844

    Article  PubMed  Google Scholar 

  7. Vogel RA (1988) The Maryland experience: angioplasty and valvuloplasty using percutaneous cardiopulmonary support. Am J Cardiol 62(18):11K–14K

    Article  CAS  PubMed  Google Scholar 

  8. Taub JO, L’Hommedieu BD, Raithel SC, Vieth DG, Vieth PJ, Barner HB, Vandormael M, Pennington DG (1989) Extracorporeal membrane oxygenation for percutaneous coronary angioplasty in high risk patients. ASAIO Trans 35(3):664–666

    Article  CAS  PubMed  Google Scholar 

  9. Ott RA, Mills TC, Tobis JM, Allen BJ, Dwyer ML (1990) ECMO assisted angioplasty for cardiomyopathy patients with unstable angina. ASAIO Trans 36(3):M483–M485

    CAS  PubMed  Google Scholar 

  10. Magovern GJ Jr, Simpson KA (1999) Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg 68(2):655–661

    Article  PubMed  Google Scholar 

  11. Silvestri M, Barragan P, Sainsous J, Bayet G, Simeoni JB, Roquebert PO, Macaluso G, Bouvier JL, Comet B (2000) Unprotected left main coronary artery stenting: immediate and medium-term outcomes of 140 elective procedures. J Am Coll Cardiol 35(6):1543–1550

    Article  CAS  PubMed  Google Scholar 

  12. Irons D, Lim YL, Lefkovits J, Esmore D (1996) Left main coronary artery stenting under extracorporeal circulatory support. Aust N Z J Med 26(6):842–843

    Article  CAS  PubMed  Google Scholar 

  13. Shammas NW, Roberts S, Early G (2002) Extracorporeal membrane oxygenation for unprotected left main stenting in a patient with totally occluded right coronary artery and severe left ventricular dysfunction. J Invasive Cardiol 14(12):756–759

    PubMed  Google Scholar 

  14. Hasdai D, Topol EJ, Califf RM, Berger PB, Holmes DR Jr (2000) Cardiogenic shock complicating acute coronary syndromes. Lancet 356(9231):749–756

    Article  CAS  PubMed  Google Scholar 

  15. Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI); Results of the primary PCI registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Eur Heart J 25(4):322–328

    Article  PubMed  Google Scholar 

  16. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 341(9):625–634

    Article  CAS  PubMed  Google Scholar 

  17. Sarkar K, Kini AS (2010) Percutaneous left ventricular support devices. Cardiol Clin 28(1):169–184

    Article  PubMed  Google Scholar 

  18. Sjauw KD, Engström AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP (2009) A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30(4):459–468

    Article  PubMed  Google Scholar 

  19. Anderson H 3rd, Steimle C, Shapiro M, Delius R, Chapman R, Hirschl R, Bartlett R (1993) Extracorporeal life support for adult cardiorespiratory failure. Surgery 114(2):161–172

    PubMed  Google Scholar 

  20. Chen JS, Ko WJ, Yu HY, Lai LP, Huang SC, Chi NH, Tsai CH, Wang SS, Lin FY, Chen YS (2006) Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue. Crit Care Med 34(4):950–957

    Article  PubMed  Google Scholar 

  21. Arlt M, Philipp A, Voelkel S, Schopka S, Husser O, Hengstenberg C, Schmid C, Hilker M (2012) Early experiences with miniaturized extracorporeal life-support in the catheterization laboratory. Eur J Cardiothorac Surg 42(5):858–863

    Article  PubMed  Google Scholar 

  22. Lai CH, Chu YS, Li WL, Wang CC, Chang Y (2008) Percutaneous coronary intervention under extracorporeal membrane oxygenation support for high-risk acute myocardial infarction with cardiogenic shock. J Med Sci 28(1):39–44

    Google Scholar 

  23. Larsen AI, Hjørnevik A, Bonarjee V, Barvik S, Melberg T, Nilsen DW (2010) Coronary blood flow and perfusion pressure during coronary angiography in patients with ongoing mechanical chest compression: a report on 6 cases. Resuscitation 81(4):493–497

    Article  PubMed  Google Scholar 

  24. Wind J, Bekkers SC, van Hooren LJ, van Heurn LW (2009) Extensive injury after use of a mechanical cardiopulmonary resuscitation device. Am J Emerg Med 27(8):1017.e1–2

    Article  PubMed  Google Scholar 

  25. Lee MS, Pessegueiro A, Tobis J (2008) The role of extracorporeal membrane oxygenation in emergent percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock and cardiac arrest. J Invasive Cardiol 20(9):E269–E272

    PubMed  Google Scholar 

  26. Tayara W, Starling RC, Yamani MH, Wazni O, Jubran F, Smedira N (2006) Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment. J Heart Lung Transplant 25(5):504–509

    Article  PubMed  Google Scholar 

  27. Rodés-Cabau J, Webb JG, Cheung A, Ye J, Dumont E, Feindel CM, Osten M, Natarajan MK, Velianou JL, Martucci G, DeVarennes B, Chisholm R, Peterson MD, Lichtenstein SV, Nietlispach F, Doyle D, DeLarochellière R, Teoh K, Chu V, Dancea A, Lachapelle K, Cheema A, Latter D, Horlick E (2010) Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol 55(11):1080–1090

    Article  PubMed  Google Scholar 

  28. Husser O, Holzamer A, Philipp A, Nunez J, Bodi V, Müller T, Lubnow M, Luchner A, Lunz D, Riegger GA, Schmid C, Hengstenberg C, Hilker M (2013) Emergency and prophylactic use of miniaturized veno-arterial extracorporeal membrane oxygenation in transcatheter aortic valve implantation. Catheter Cardiovasc Interv 82(4):E542–E551

    Google Scholar 

  29. Jeppsson A, Liden H, Johnsson P, Hartford M, Rådegran K (2005) Surgical repair of post infarction ventricular septal defects: a national experience. Eur J Cardiothorac Surg 27(2):216–221

    Article  PubMed  Google Scholar 

  30. Fukushima S, Tesar PJ, Jalali H, Clarke AJ, Sharma H, Choudhary J, Bartlett H, Pohlner PG (2010) Determinants of in-hospital and long-term surgical outcomes after repair of postinfarction ventricular septal rupture. J Thorac Cardiovasc Surg 140(1):59–65

    Article  PubMed  Google Scholar 

  31. Thiele H, Kaulfersch C, Daehnert I, Schoenauer M, Eitel I, Borger M, Schuler G (2009) Immediate primary transcatheter closure of postinfarction ventricular septal defects. Eur Heart J 30(1):81–88

    Article  PubMed  Google Scholar 

  32. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS, Vahanian A, Califf RM, Topol EJ (2000) Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators. Circulation 101(1):27–32

    Article  CAS  PubMed  Google Scholar 

  33. Menon V, Webb JG, Hillis LD, Sleeper LA, Abboud R, Dzavik V, Slater JN, Forman R, Monrad ES, Talley JD, Hochman JS (2000) Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. J Am Coll Cardiol 36:1110–1116

    Article  CAS  PubMed  Google Scholar 

  34. Tsai M, Wu H, Chan S, Luo C (2012) Extracorporeal membrane oxygenation as a bridge to definite surgery in recurrent postinfarction ventricular septal defect. ASAIO J 58:88–89

    Article  PubMed  Google Scholar 

  35. Rohn V, Spacek M, Belohlavek J, Tosovsky J (2009) Cardiogenic shock in patient with posterior postinfarction septal rupture – successful treatment with extracorporeal membrane oxygenation (ECMO) as a ventricular assist device. J Card Surg 24:435–436

    Article  PubMed  Google Scholar 

  36. Pitsis AA, Kelpis TG, Visouli AN, Bobotis G, Filippatos GS, Kremastinos DT (2008) Left ventricular assist device as a bridge to surgery in postinfarction ventricular septal defect. J Thorac Cardiovasc Surg 135:951–952

    Article  PubMed  Google Scholar 

  37. Alba AC, Rao V, Ivanov J, Ross HJ, Delgado DH (2009) Usefulness of the INTERMACS scale to predict outcomes after mechanical assist device implantation. J Heart Lung Transplant 28:827–833

    Article  PubMed  Google Scholar 

  38. Formica F, Avalli L, Colagrande L, Ferro O, Greco G, Maggioni E, Paolini G (2010) Extracorporeal membrane oxygenation to support adults with cardiac failure: predictive factors of 30 day mortality. Interact Cardiovasc Thorac Surg 10:721–726

    Article  PubMed  Google Scholar 

  39. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP, ESC Committee for Practice Guidelines (CPG) (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29(18):2276–2315

    Article  CAS  PubMed  Google Scholar 

  40. Norita H, Ohteki H, Hisanou R (1994) Emergency pulmonary embolectomy for massive pulmonary embolism. J Jpn Coll Angiol 34:3–9

    Google Scholar 

  41. Rajdev S, Benza R, Misra V (2007) Use of Tandem Heart as a temporary hemodynamic support option for severe pulmonary artery hypertension complicated by cardiogenic shock. J Invasive Cardiol 19(8):E226–E229

    PubMed  Google Scholar 

  42. Misawa Y, Fuse K, Yamaguchi T, Saito T, Konishi H (2000) Mechanical circulatory assist for pulmonary embolism. Perfusion 15(6):527–529

    Article  CAS  PubMed  Google Scholar 

  43. Deehring R, Kiss AB, Garrett A, Hillier AG (2006) Extracorporeal membrane oxygenation as a bridge to surgical embolectomy in acute fulminant pulmonary embolism. Am J Emerg Med 24(7):879–880

    Article  PubMed  Google Scholar 

  44. Howes J, Khilkin M, DeRose J, Dicpinigaitis P, Dulu A (2011) Veno-arterial extracorporeal membrane oxygenation as a salvage therapy in massive pulmonary embolism. Chest 140(4_MeetingAbstracts):64A. doi:10.1378/chest.1117995

    Article  Google Scholar 

  45. Belohlavek J, Rohn V, Jansa P, Tosovsky J, Kunstyr J, Semrad M, Horak J, Lips M, Mlejnsky F, Balik M, Klein A, Linhart A, Lindner J (2010) Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern. J Invasive Cardiol 22(8):365–369

    PubMed  Google Scholar 

  46. Miyamoto S, Hadama T, Mori Y et al (1995) Hemodynamic profiles during concurrent intraaortic balloon pumping and venoarterial bypass — a canine study comparing subclavian and femoral artery perfusion sites. Jpn Circ J 59:693–703

    Article  CAS  PubMed  Google Scholar 

  47. Koster A, Weng Y, Böttcher W, Gromann T, Kuppe H, Hetzer R (2007) Successful use of bivalirudin as anticoagulant for ECMO in a patient with acute HIT. Ann Thorac Surg 83(5):1865–1867

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The Baird Research Institute for Applied Heart and Lung Surgical Research, Royal Prince Alfred Hospital, The University of Sydney, Missenden Road, Sydney, NSW, 2050, Australia

    Fabio Ramponi MD, FEBVS & Korana Musicki MBBS

  2. Department of Cardiothoracic Anaesthesia, The Baird Research Institute for Applied Heart and Lung Surgical Research, Royal Prince Alfred Hospital, The University of Sydney, Missenden Road, Sydney, NSW, 2050, Australia

    Paul Forrest MBChB, FANZCA & Michael P. Vallely PhD, FRACS

  3. Department of Intensive Care, The Prince Charles Hospital, The University of Queensland, 627 Rode Road, Brisbane, QLD, 4032, Australia

    John F. Fraser PhD, MRCP, FRCA, FFARCSI, FCICM

Authors
  1. Fabio Ramponi MD, FEBVS
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  2. Paul Forrest MBChB, FANZCA
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  3. John F. Fraser PhD, MRCP, FRCA, FFARCSI, FCICM
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  4. Korana Musicki MBBS
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  5. Michael P. Vallely PhD, FRACS
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Corresponding author

Correspondence to Fabio Ramponi MD, FEBVS .

Editor information

Editors and Affiliations

  1. Department of Anaesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza (MB), Italy

    Fabio Sangalli

  2. Department of Health Sciences Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza (MB), Italy

    Nicolò Patroniti

  3. Health Science Departement, Università Milano Bicocca Facoltà Medicina e Chirurgia, Monza (MB), Italy

    Antonio Pesenti

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Ramponi, F., Forrest, P., Fraser, J.F., Musicki, K., Vallely, M.P. (2014). ECMO for High-Risk Procedures. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_13

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  • DOI: https://doi.org/10.1007/978-88-470-5427-1_13

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-5426-4

  • Online ISBN: 978-88-470-5427-1

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