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Role of ECMO in Acute Cardiogenic Shock

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Presentation on theme: "Role of ECMO in Acute Cardiogenic Shock"— Presentation transcript:

1 Role of ECMO in Acute Cardiogenic Shock
Ezequiel J Molina, MD Attending Cardiac Surgeon Advanced Heart Failure and Transplant Program MedStar Heart and Vascular Institute – Washington Hospital Center Washington, DC I have no relevant financial relationships

2 Background Mortality rate of refractory cardiogenic shock is high
Early initiation of MCS (ECMO) may improve outcomes Avoid progression of MSOF and optimize organ function Potential outcomes: Heart recovery Temporary or durable LVAD Heart transplantation Withdrawal of care and death

3 Ideal Support Device Easy and rapid implementation
Provide robust hemodynamic support Biventricular support when needed Allow pulmonary support Cost effective Multidisciplinary team approach

4 Device Selection Patient status and location
Etiology of cardiogenic shock Technology available at your institution Devices: VA ECMO CentriMag LVAD Impella Tandem Heart

5 VA ECMO

6 VA ECMO Abrams et al, J Am Coll Cardiol, 2014

7 ECMO Management MAP > 65 (minimize vasopressors)
Adequate volume resuscitation Allow cardiac ejection and pulmonary flow Monitor for bleeding, thrombosis and sepsis Anticoagulation (ACT sec) Monitor organ recovery Weaning strategies Multidisciplinary team approach

8 ECMO Advantages Allows for minimally invasive
Rapid bedside application Biventricular support Pulmonary support Low initial cost Transport capabilities

9 ECMO Advantages

10 ECMO Disadvantages Labor intensive High cost with prolonged support
Requires anticoagulation LV distension / thrombosis Historically high complication rates Limited duration of support

11 ECMO Disadvantages Burkhoff et al, J Am Coll Cardiol. 2015

12 LV Distension Inotropes Minimize vasoconstriction Central cannulation
LV vent insertion Impella / Tandem Heart LVAD conversion

13 Device Comparisson Thiele et al, European Heart J. 2015

14 ELSO Survival Data

15 ECMO Outcomes AMI Negi et al, J Invasive Cardiol, 2016

16 ECMO Outcomes AMI Negi et al, J Invasive Cardiol, 2016

17 CentriMag LVAD Takayama et al, J Heart Lung Transplant, 2013

18 Conclusions Early and rapid recognition of cardiogenic shock
Robust hemodynamic support may improve outcomes ECMO is our first line of therapy for cardiopulmonary support… before MSOF Bridge to bridge, recovery, transplantation or durable LVADs Survival to hospital discharge 20-40% Management guidelines are needed but difficult to develop Teamwork and communication at each stage is critical

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