Nersesian Gaik, Lewin Daniel, Ott Sascha, Schoenrath Felix, Hrytsyna Yuriy, Starck Christoph, Spillmann Frank, O'Brien Benjamin, Falk Volkmar, Potapov Evgenij, Lanmueller Pia
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4). doi: 10.1093/icvts/ivae043.
The combination of veno-arterial extracorporeal membrane oxygenation with a micro-axial flow pump (ECMELLA) is increasingly used for cardiogenic shock (CS) therapy. We report our experience with a novel single-artery access ECMELLA setup with either femoral (2.0) or jugular venous cannulation (2.1), respectively.
Data from 67 consecutive CS patients treated with ECMELLA 2.0 (n = 56) and 2.1 (n = 11) from December 2020 and December 2022 in a tertiary cardiac center were retrospectively analyzed.
The mean age was 60.7 ± 11 years, 56 patients (84%) were male. CS aetiology was acute on chronic heart failure (n = 35, 52%), myocardial infarction (n = 13, 19.5%), postcardiotomy syndrome (n = 16, 24%) and myocarditis (n = 3, 4.5%). Preoperatively 31 patients (46%) were resuscitated, 53 (79%) were on a ventilator and 60 (90%) were on inotropic support. The median vasoactive inotropic score was 32, and the mean arterial lactate was 8.1 mmol/l. In 39 patients (58%), veno-arterial extracorporeal membrane oxygenation was explanted after a median ECMELLA support of 4 days. Myocardial recovery was achieved in 18 patients (27%), transition to a durable left ventricular assist device in 16 (24%). Thirty-three patients (n = 33; 49%) died on support (25 on ECMELLA and 8 on Impella after de-escalation), 9 (13%) of whom were palliated. Axillary access site bleeding occurred in 9 patients (13.5%), upper limb ischaemia requiring surgical revision in 3 (4.5%). Axillary site infection occurred in 6 cases (9%), and perioperative stroke in 10 (15%; 6 hemorrhagic, 4 thromboembolic).
ECMELLA 2.0/2.1 is a feasible and effective therapy for severe CS. The single-artery cannulation technique is associated with a relatively low rate of access-related complications.
静脉 - 动脉体外膜肺氧合联合微轴流泵（ECMELLA）越来越多地用于心源性休克（CS）治疗。我们报告了我们分别采用股动脉（2.0）或颈静脉插管（2.1）的新型单动脉入路ECMELLA装置的经验。
回顾性分析了2020年12月至2022年12月在一家三级心脏中心接受ECMELLA 2.0（n = 56）和2.1（n = 11）治疗的67例连续CS患者的数据。
平均年龄为60.7±11岁，56例患者（84%）为男性。CS病因包括慢性心力衰竭急性发作（n = 35，52%）、心肌梗死（n = 13，19.5%）、心脏术后综合征（n = 16，24%）和心肌炎（n = 3，4.5%）。术前31例患者（46%）接受了心肺复苏，53例（79%）使用呼吸机，60例（90%）接受了血管活性药物支持。血管活性药物评分中位数为32，平均动脉血乳酸为8.1 mmol/L。39例患者（58%）在ECMELLA支持中位数4天后撤除静脉 - 动脉体外膜肺氧合。18例患者（27%）实现心肌恢复，16例（24%）过渡到持久性左心室辅助装置。33例患者（n = 33；49%）在支持过程中死亡（25例在ECMELLA支持期间，8例在降级后使用Impella期间），其中9例（13%）接受了姑息治疗。9例患者（13.5%）出现腋动脉入路部位出血，3例（4.5%）出现上肢缺血需要手术修复。6例（9%）发生腋部感染，10例（15%；6例出血性，4例血栓栓塞性）发生围手术期卒中。
ECMELLA 2.0/2.1是治疗严重CS的一种可行且有效的方法。单动脉插管技术相关的入路相关并发症发生率相对较低。
