Lori Edwards

The use of percutaneous ECMO support as a 'bridge to bridge' in heart failure patients: a case report.

A 65-year-old male with a known history of ischemic cardiomyopathy was admitted to the intensive care unit in cardiogenic shock. Cardiac catheterization revealed bi-ventricular hypokinesis, with an estimated ejection fraction of 15%. Despite moderate inotropic support, the patient’s liver enzymes, international normalization ratio (INR), and creatinine became grossly elevated, indicating multi-organ injury from hypoperfusion. Due to the patient’s state of shock and probable bleeding complications, a full sternotomy and emergent biventricular assist device insertion was deemed very high risk. In order to achieve hemodynamic stability, a decision was made for extracorporeal membrane oxygenation (ECMO) support. ECMO support was quickly initiated by percutaneous cannulation of the femoral vein and artery. The ECMO circuit was comprised of a Centrimag blood pump and Quadrox-D Safeline-coated membrane oxygenator. With successful perfusion and organ resuscitation, abnormal liver function tests, INR, and creatinine all returned to normal in less than one week. With normal organ function, especially the liver, the patient successfully underwent an implantable left ventricular assist device, HeartMate II LVAD, without requiring mechanical right heart support. Prior to ECMO, the patient was at very high risk of needing biventricular support. Thus, the temporary use of ECMO allowed for a safer and more durable bridge to transplantation. The use of percutaneous ECMO has many advantages, including improving the patient condition and allowing for time to evaluate fully the LVAD patient.

Ambulatory Ventricular Assist Device Patient Management

Understanding the ventricular assist device (VAD) patient pump interface and developing expertise in monitoring patients with a VAD are the goals of care in the ambulatory setting. The objective is to improve long-term outcomes. The purpose of expert, focused, routine outpatient surveillance is to facilitate the integration of pulseless, electrically dependent VAD patients into the community. Other goals of outpatient care include maximizing quality of life, maintaining equipment integrity, treating heart failure symptoms, monitoring for common VAD-related complications, ensuring viability as a heart transplant candidate, consideration for patients implanted to become transplantable, and monitoring for possible cardiac recovery.