Clinical Significance of Spontaneous Echo Contrast on Extracorporeal Membrane Oxygenation

Thursday, October 13, 2016

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Source

Source Name: Annals of Thoracic Surgery

Source URL: http://www.annalsthoracicsurgery.org/article/S0003-4975(16)30914-6/fulltext

Author(s)

Shinya Unai, MD, My-Le Nguyen, MD, Daizo Tanaka, MD, Nataliya Gorbachuk, BA, Gregary D. Marhefka, MD, Hitoshi Hirose, MD, Nicholas C. Cavarocchi, MD

This single-center study explored the relationship between spontaneous echo contrast (SEC) and the incidence of thromboembolism and CVA in 98 patients undergoing peripheral VA ECMO. Twenty-two percent of patients had SEC while they were on ECMO. Those exhibiting SEC had significantly higher rates of intracardiac thrombus (46% v. 13%, p = 0.002) and CVA (36% v. 7.9%, p = 0.002). The patients who showed SEC had a lower EF and less frequent aortic valve opening.

Comment: Should we be venting the LV more frequently in VA ECMO? If so, how should we vent the LV? Alternatively, should we maintain a baseline level of inotropic support on these patients to discourage stasis in the LV?

Comments

Submitted by Dominick Carella on Fri, 2016-10-21 17:27

Yes and Yes. More and More VA experience seems to support this if we want to salvage the heart and not just place patients on ECMO. The cannulae don't have to be that big. Percutaneous left-heart decompression, left atrial decompression with trans-septal puncture and placement of a drain (8- to 15-Fr) incorporated into the venous side of the circuit, blade or balloon atrial septostomy, or directly if the patient has an open chest, impellar possibly, but combined IABP and ECMO treatment does not improve outcomes in patients with circulatory failure. Dominick M. Carella RN MSN MBA| ECMO Coordinator The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital One Robert Wood Johnson Place |Office 6111 | New Brunswick | NJ 08903 Office Phone: 732-253-3847| Cell Phone: 732-336-0573 | dominick.carella@rwjbh.org

Submitted by Dominick Carella on Fri, 2016-10-21 17:33

Its not to say that its not worth a try of the Impella. There has been some reports of 2.5 to 5.0 used....some mixed results for LV decompression and some patients were switched to other "longer-term" devices.