Shimizu Shinya, Shimano Masayuki, Shibata Yoshihisa, Hanaki Yoshihiro, Kamiya Haruo, Morimoto Ryota, Okumura Takahiro, Murohara Toyoaki
Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiol Cases. 2020 May 27;22(3):103-106. doi: 10.1016/j.jccase.2020.05.004. eCollection 2020 Sep.
The Impella™ (Abiomed, Danvers, MA, USA) is a percutaneous left ventricular assist device and is concurrently used with veno-arterial extracorporeal membrane oxygenation (VA ECMO). However, concomitantly using these two devices makes identifying the mixed zone of two opposite blood flows difficult. We report the case of an 80-year-old man with ST-elevation myocardial infarction and cardiopulmonary arrest. Emergent coronary angiography showed 99% stenosis in the left main trunk. A drug-eluting stent was placed under support of VA ECMO and the Impella2.5 for cardiogenic shock. During this support, antegrade deoxygenated blood enhanced by the Impella was sent to the right radial artery. Inadequate oxygenated blood was delivered through the native lung, which was damaged by cardiopulmonary resuscitation. We decided to convert to veno-venous and arterial ECMO (V-VA ECMO) using additional venous cannulation as drainage. Returned oxygenated blood was sent to the inferior vena cava and femoral artery bilaterally for maintaining oxygenation in the pulmonary artery. In V-VA ECMO and the Impella (v-ECPELLA), we attempted weaning from VA ECMO by only clamping VA cannulation and switching to veno-venous ECMO. We restored the setting to VA ECMO after assessment of the systemic circulation. We successfully managed and weaned our patient from simultaneous use of VA ECMO and the Impella2.5 by using v-ECPELLA. Simultaneous use of the Impella and veno-arterial extracorporeal membrane oxygenation (VA ECMO) is sometimes required in cases with severe lung injury. However, using these two devices may increase unexpected perfusion of unoxygenated blood in the coronary and cerebral arts. Veno-venous and arterial ECMO with the Impella can reduce the risk of hypoxia because of returned oxygenated blood to the inferior vena cava. This method might be useful for maintaining and weaning from simultaneous use of VA ECMO and the Impella.>.
Impella™（美国马萨诸塞州丹弗斯市的Abiomed公司生产）是一种经皮左心室辅助装置，常与静脉-动脉体外膜肺氧合（VA ECMO）同时使用。然而，同时使用这两种装置会使识别两股相反血流的混合区域变得困难。我们报告了一例80岁男性ST段抬高型心肌梗死合并心肺骤停的病例。急诊冠状动脉造影显示左主干狭窄99%。在VA ECMO和Impella 2.5的支持下，为心源性休克患者植入了药物洗脱支架。在此支持过程中，由Impella增强的顺行脱氧血被输送到右桡动脉。通过因心肺复苏受损的天然肺输送的氧合血不足。我们决定通过额外的静脉插管作为引流，转换为静脉-静脉和动脉体外膜肺氧合（V-VA ECMO）。返回的氧合血被双侧输送到下腔静脉和股动脉，以维持肺动脉的氧合。在V-VA ECMO和Impella（v-ECPELLA）中，我们尝试仅通过夹闭VA插管并转换为静脉-静脉体外膜肺氧合来撤离VA ECMO。在评估体循环后，我们将设置恢复为VA ECMO。我们通过使用v-ECPELLA成功管理并使患者从同时使用VA ECMO和Impella 2.5中撤离。在严重肺损伤的病例中，有时需要同时使用Impella和静脉-动脉体外膜肺氧合（VA ECMO）。然而，使用这两种装置可能会增加冠状动脉和脑动脉中未氧合血的意外灌注。带有Impella的静脉-静脉和动脉体外膜肺氧合可以降低因氧合血返回下腔静脉而导致缺氧的风险。这种方法可能有助于维持和撤离同时使用的VA ECMO和Impella。
