Introduction to Refractory Cardiogenic

CASE REPORT This report concerns a case of refractory cardiogenic shock due to acute myocarditis in a 35-year-old puerperal female patient who presented with retrosternal pain, fatigue and dyspnea.

Methods This is a retrospective review of 33 patients with refractory cardiogenic shock requiring VA ECMO who underwent surgical LV vent placement between July 2015 and March 2020.

6%) had refractory cardiogenic shock, 7 patients (11.

Indications We suggest VA ECMO be considered for poisoned patients with refractory cardiogenic shock (continued shock with myocardial dysfunction despite fluid resuscitation, vasoactive support, and indicated toxicologic therapies such as glucagon, intravenous lipid emulsion, hyperinsulinemia euglycemia therapy, or others), and strongly considered for patients with cardiac arrest in institutions which are structured to deliver effective ECPR.

This review discusses the preferred approaches, cannulation techniques, and available support devices ideal for the various clinical situations encountered during the treatment of cardiac arrest and refractory cardiogenic shock.

Results Thirty-five patients were admitted because of refractory cardiogenic shock (26 of 35 survived) and the remaining 36 patients due to cardiac arrest (13 of 36 survived).

RESULTS 114 veino-arterial ECMOs were implanted for refractory cardiogenic shock after 5702 cardiac surgeries (1.

All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018–12/2020).

Acute myocardial infarction with refractory cardiogenic shock (AMI-RCS) is associated with poor outcomes.

Studies that included post-cardiotomy, septic shock, respiratory failure or refractory cardiogenic shock were excluded.

Methods: This retrospective single-center study included 265 adults supported by VA-ECMO for refractory cardiogenic shock from January 2015 to June 2019.

The study included 65 adult patients supported with femoral VA-ECMO for refractory cardiogenic shock.

Veno-arterial membrane oxygenation (VA-ECMO) can be used as a rescue therapy for patients in refractory cardiogenic shock.

In our patient, cardiac catheterization which was performed during his hospitalization confirmed no ischemic disease and suggested the presence of myocarditis which was ultimately fatal in the setting of refractory cardiogenic shock.

Treatment of refractory cardiogenic shock has poor outcome.

Discussion: The addition of LV Impella and RV support by Impella (BiPELLA) on top of VA-ECMO may support survival of patients with refractory cardiogenic shock.

The 3rd case is a 45-year-old patient carrying a dilated cardiomyopathy with severe biventricular dysfunction and multivisceral failure who benefited from a VA ECMO for a refractory cardiogenic shock as a “bridge to heart transplant”.

A subset of these advanced HF patients deteriorates into refractory cardiogenic shock, that is challenging to manage with vasoactive agents alone.

All consecutive patients who underwent peripheral femoro-femoral VA-ECMO percutaneous implantation for refractory cardiogenic shock or cardiac arrest were enrolled in a prospective registry (03/2018-09/2020).

Discussion Pheochromocytoma crisis turned into a potential catastrophic scenario, characterized by refractory cardiogenic shock requiring circulatory supportive devices and PRES.

We report the case of a 69-year-old man suffering from a refractory cardiogenic shock, without significant lung involvement.

She was transferred to a tertiary care center in refractory cardiogenic shock for ECMO evaluation.

The Swan-Ganz monitoring was not consistent with the refractory cardiogenic shock following hepatopathy.

Subsequently, she progressed to refractory cardiogenic shock necessitating four vasopressor agents.

However, due to refractory cardiogenic shock, peripheral veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) was instituted immediately via right common femoral cannulation: 25F venous, 17F arterial, and 6F distal arterial reperfusion.

The indications were refractory hypoxaemic respiratory failure in 9, tracheo-oesophageal fistula and respiratory failure in 1, support during surgery for planned tracheal reconstruction in 1, and refractory cardiogenic shock in 3 patients.

Severe acute respiratory distress syndrome (ARDS) and/or refractory cardiogenic shock or cardiac arrest caused by toxins are associated with high mortality and are difficult to treat.

5 to improve native heart function in refractory cardiogenic shock and further indicate its use as an option for those in acute decompensated heart failure who have tested positive for COVID-19 infection.

Due to refractory cardiogenic shock and prohibitive cardiac surgical risk, weight-based intravenous tenecteplase was administered emergently.

An emerging therapeutic modality, ECPELLA, which combines a transvalvular microaxial left ventricular (LV) assist device, Impella, and venoarterial membrane oxygenation (VA‐ECMO), has been applied for patients with refractory cardiogenic shock.

Conclusion Complete percutaneous angio-guided VA-ECMO implantation and decannulation using pre-closing technique is an effective and safe strategy in patients referred for refractory cardiogenic shock or cardiac arrest.

The second case is a refractory cardiogenic shock due to left main stent thrombosis myocardial infarction.

Case Report 58-year-old gentleman with long-standing NICM, LV EF 20-25%, atrial fibrillation (AF), CKD stage III, recent COVID-19, presented with an ST elevation myocardial infarction and progressed to refractory cardiogenic shock.

Purpose Veno-arterial (VA) ECMO plays a central role in patients with refractory cardiogenic shock.

Introduction Patients with refractory cardiogenic shock have a mortality in excess of 80%.

BackgroundExtracorporeal membrane oxygenation offers temporary hemodynamic support for patients with refractory cardiogenic shock after cardiovascular surgery.

This chapter summarizes the key points for clinicians regarding the specific management of patients with refractory acute respiratory distress syndrome on venovenous ECMO and those with refractory cardiogenic shock supported by venoarterial ECMO.

The patient evolved to refractory cardiogenic shock despite the clinical measures applied.

Purpose To investigate the outcome of patients in refractory cardiogenic shock who required VA ECMO as a bridge to durable LVAD Methods This is a retrospective review of all adult INTERMACS profile 1 patients who underwent LVAD implantation at our institution between 01/01/2015 and 12/31/2017.

RESULTS Predictors of neurological complications were refractory cardiogenic shock following cardiotomy (OR = 0.