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Medicina
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Strategies and Concepts of Extracorporeal Life Support
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Strategies and Concepts of Extracorporeal Life Support

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 12355

Special Issue Editor

Dr. Dominik Wiedemann

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
Interests: extracorporeal membrane oxygenation (ECMO); mechanical circulatory support (MCS); ventricular assist devices (VAD); minimally invasive cardiac surgery; pediatric cardiac surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Extracorporeal life support (ECLS) is a technique for cardiac and/or pulmonary support if other more conservative measures are not able to sustain an adequate perfusion and/or gas exchange. Largely derived from cardiopulmonary bypass, the technique was developed during the early 1970s. However, after the initial enthusiasm, ECLS was regarded as useless or as an experimental method just to delay death, but not as a true treatment modality. Technological evolution together with improvements in the management of ECLS patients has led to significantly better outcomes and wider adoption of the technique. Nowadays, ECLS is used for the treatment of a broad variety of cardiac and/or pulmonary diseases, either with the target to recover the respective organs or as a bridge to organ transplantation or durable mechanical circulatory support. Despite all the improvements, the outcome after ECLS is still limited, and this is partly related to the patient’s critical status but also to the associated complications. The scientific literature on this topic is scarce, and thus this Special Issue aims to collect clinical reports, experimental data, and reviews on new strategies and concepts of ECLS in order to increase the knowledge and acceptance of this therapy within the medical community.

Dr. Dominik Wiedemann
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • extracorporeal life support (ECLS)
  • extracorporeal membrane oxygenation (ECMO)
  • mechanical circulatory support
  • post cardiotomy ECLS
  • heart failure
  • respiratory failure

Published Papers (4 papers)

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Research

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8 pages, 2552 KiB  
Communication
St. Thomas Modified Cardioplegia Effects on Myoblasts’ Viability and Morphology
by Rafał Nowicki, Katarzyna Bieżuńska-Kusiak, Julita Kulbacka, Anna Choromanska, Małgorzata Daczewska, Stanisław Potoczek, Maciej Rachwalik and Jolanta Saczko
Medicina 2022, 58(2), 280; https://doi.org/10.3390/medicina58020280 - 13 Feb 2022
Viewed by 2770
Abstract
Background and Objectives: The cardioplegic arrest of the heart during cardiosurgical procedures is the crucial element of a cardioprotection strategy. Numerous clinical trials compare different cardioplegic solutions and cardioprotective protocols, but a relatively small number of papers apply to in vitro conditions [...] Read more.
Background and Objectives: The cardioplegic arrest of the heart during cardiosurgical procedures is the crucial element of a cardioprotection strategy. Numerous clinical trials compare different cardioplegic solutions and cardioprotective protocols, but a relatively small number of papers apply to in vitro conditions using cultured cells. This work aimed to analyze whether it is possible to use the rat heart myocardium cells as an in vitro model to study the protective properties of St. Thomas cardioplegia (ST2C). Methods: The rat heart myocardium cells-H9C2 were incubated with cold cardioplegia for up to 24 h. After incubation, we determined: viability, confluency, and cell size, the thiol groups’ level by modifying Ellman’s method, Ki67, and Proliferating Cell Nuclear Antigen expression (PCNA). The impact on cells’ morphology was visualized by the ultrastructural (TEM) study and holotomograpic 3D imaging. Results: The viability and confluency analysis demonstrated that the safest exposure to ST2C, should not exceed 4h. An increased expression of Ki67 antigen and PCNA was observed. TEM and 3D imaging studies revealed vacuolization after the longest period of exposure (24). Conclusions: According to obtained results, we conclude that STC can play a protective role in cardiac surgery during heart arrest. Full article
(This article belongs to the Special Issue Strategies and Concepts of Extracorporeal Life Support)
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9 pages, 423 KiB  
Article
Awake Implementation of Extracorporeal Life Support in Refractory Cardiogenic Shock
by Julia Riebandt, Thomas Haberl, Klaus Distelmaier, Martin H. Bernardi, Anne-Kristin Schaefer, Guenther Laufer, Daniel Zimpfer and Dominik Wiedemann
Medicina 2022, 58(1), 43; https://doi.org/10.3390/medicina58010043 - 28 Dec 2021
Cited by 1 | Viewed by 1948
Abstract
Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated [...] Read more.
Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated with the need for sedation and intubation. The aim of the study was the assessment of safety and feasibility of awake ECLS implementation and of outcomes in patients treated with this concept. Materials and Methods: We retrospectively reviewed the concept of awake ECLS implantation in 16 consecutive patients (mean age 58 ± 8 years; male: 88%; ischemic cardiomyopathy: 50%) from 02/2017 to 01/2021. Study endpoints were survival to weaning or bridging to durable support or organ replacement and development of end-organ function and hemodynamic parameters on ECLS. Results: Fourteen patients (88%) were able to be successfully transitioned to definite therapy options. ECLS support stabilized end-organ function, led to a decrease in mean lactate levels (5.3 ± 3.7 mmol/L at baseline to 1.9 ± 1.3 mmol/L 12 h after ECLS start; p = 0.01) and improved hemodynamics (median central venous pressure 20 ± 5 mmHg vs. 10 ± 2 mmHg, p = 0.001) over a median duration of two days (1–8 days IQR). Two patients (13%) died on ECLS support due to multi-organ dysfunction syndrome. Survival to discharge of initially successfully bridged or weaned patients was 64%. Conclusions: Awake ECLS implantation is feasible and safe with the key advantage of omitting or delaying general anesthesia and intubation, with their associated risks in cardiogenic-shock patients, facilitating further decision making. Full article
(This article belongs to the Special Issue Strategies and Concepts of Extracorporeal Life Support)
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Review

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11 pages, 318 KiB  
Review
ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture
by Garrett Coyan, Neesha Anand, Mahnoor Imran, Hernando Gomez, Raj Ramanan, Holt Murray, Saurabh Sanon, Pyongsoo Yoon, David Kaczorowski and Johannes Bonatti
Medicina 2022, 58(5), 611; https://doi.org/10.3390/medicina58050611 - 28 Apr 2022
Cited by 10 | Viewed by 3602
Abstract
Background and Objectives: Post-infarct ventricular septal rupture (PIVSR) continues to have significant morbidity and mortality, despite decreased prevalence. Impella and venoarterial extracorporeal membranous oxygenation (VA-ECMO) have been proposed as strategies to correct hemodynamic derangements and bridge patients to delayed operative repair when success [...] Read more.
Background and Objectives: Post-infarct ventricular septal rupture (PIVSR) continues to have significant morbidity and mortality, despite decreased prevalence. Impella and venoarterial extracorporeal membranous oxygenation (VA-ECMO) have been proposed as strategies to correct hemodynamic derangements and bridge patients to delayed operative repair when success rates are higher. This review places VA-ECMO and Impella support strategies in the context of bridging patients to successful PIVSR repair, with an additional case report of successful bridging with the Impella device. Materials and Methods: We report a case of PIVSR repair utilizing 14 days of Impella support. We additionally conducted a systematic review of contemporary literature to describe the application of VA-ECMO and Impella devices in the pre-operative period prior to surgical PIVSR correction. Expert commentary on the advantages and disadvantages of each of these techniques is provided. Results: We identified 19 studies with 72 patients undergoing VA-ECMO as a bridge to PIVSR repair and 6 studies with 11 patients utilizing an Impella device as a bridge to PIVSR repair. Overall, outcomes in both groups were better than expected from patients who were historically managed with medicine and balloon pump therapy, however there was a significant heterogeneity between studies. Impella provided for excellent left ventricular unloading, but did result in some concerns for reversal of shunting. VA-ECMO resulted in improved end-organ perfusion, but carried increased risks of device-related complications and requirement for additional ventricular unloading. Conclusions: Patients presenting with PIVSR in cardiogenic shock requiring a MCS bridge to definitive surgical repair continue to pose a challenge to the multidisciplinary cardiovascular team as the diverse presentation and management issues require individualized care plans. Both VA-ECMO and the Impella family of devices play a role in the contemporary management of PIVSR and offer distinct advantages and disadvantages depending on the clinical scenario. The limited case numbers reported demonstrate feasibility, safety, and recommendations for optimal management. Full article
(This article belongs to the Special Issue Strategies and Concepts of Extracorporeal Life Support)
17 pages, 1032 KiB  
Review
Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Fulminant Myocarditis: A Review of Contemporary Literature
by Shreyas Venkataraman, Abhishek Bhardwaj, Peter Matthew Belford, Benjamin N. Morris, David X. Zhao and Saraschandra Vallabhajosyula
Medicina 2022, 58(2), 215; https://doi.org/10.3390/medicina58020215 - 1 Feb 2022
Cited by 6 | Viewed by 3461
Abstract
Fulminant myocarditis is characterized by life threatening heart failure presenting as cardiogenic shock requiring inotropic or mechanical circulatory support to maintain tissue perfusion. There are limited data on the role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the management of fulminant myocarditis. This [...] Read more.
Fulminant myocarditis is characterized by life threatening heart failure presenting as cardiogenic shock requiring inotropic or mechanical circulatory support to maintain tissue perfusion. There are limited data on the role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the management of fulminant myocarditis. This review seeks to evaluate the management of fulminant myocarditis with a special emphasis on the role and outcomes with VA-ECMO use. Full article
(This article belongs to the Special Issue Strategies and Concepts of Extracorporeal Life Support)
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