Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

Extracorporeal cardiopulmonary resuscitation involves the application of venoarterial extracorporeal membrane oxygenation for patients in cardiac arrest who have received good quality conventional cardiopulmonary resuscitation, and who are deemed to have a reversible cause and no contraindications. Systemic perfusion is maintained by the extracorporeal life support, allowing time for the underlying cause to be treated and the heart to recover. Specific considerations to promote cardiac recovery are discussed, including the maintenance of sinus rhythm, promotion of cardiac ejection, management of pulmonary hypertension, management of intravascular volume, and prevention of ventricular distention.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Review Article Source Type: research

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p T Abstract The perioperative management of patients with pulmonary hypertension requires an in-depth knowledge of the underlying disease, its related pathophysiology, effects of anaesthesia and surgery, as well as the appropriate pharmacotherapy. With respect to preoperative assessment, it is essential to review all available diagnostic findings, evaluate the patient's physical state, and to plan the anaesthetic procedure. Intraoperatively, the prevention of increases in pulmonary resistance and right ventricular decompensation appears essential. For this purpose, stress, hypothermia, decreased systemic perfusio...
Source: Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS - Category: Intensive Care Authors: Tags: Anasthesiol Intensivmed Notfallmed Schmerzther Source Type: research
Rationale: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease with a poor prognosis, characterized by chronic thromboembolic obstruction of the pulmonary arteries and pulmonary hypertension. Balloon pulmonary angioplasty (BPA) is a newly emergent treatment for CTEPH, which may substitute pulmonary endarterectomy, the standard but more invasive treatment for CTEPH. Here, we report the case of a CTEPH patient who underwent 2 noncardiac surgeries without complications after preoperative intervention of BPA. Patient concerns: A 79-year-old man presented with severe osteoarthritis of bilateral knees, with a...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Pulmonary arterial hypertension (PH) is common in cardiac surgery patients, and management of this condition is challenging.1 –3 Although nonselective pulmonary vasodilators provide effective reduction in pulmonary artery pressures, they also reduce systemic vascular resistance and may negatively affect vital organ perfusion.2 For these reasons, there is growing interest in administering nonselective pulmonary vasodilato rs such as milrinone directly into the pulmonary vasculature by inhalation, to avoid hypotensive complications.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
Abstract Obstructive sleep apnea (OSA) is associated with significant cardiovascular consequences, including pulmonary hypertension. Yet, little is known about its effects on pulmonary microvascular perfusion. To investigate this, we clamped the tracheal cannulas of anesthetized, spontaneously breathing rats to simulate obstructive apnea. The clamp remained in place for 10 breaths before it was released to allow the animals to again breathe spontaneously. We repeated this every 20 seconds until the rat experienced a total of 5 apneic episodes of 10 breaths each. We then infused into a femoral vein 108 4 µm d...
Source: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology - Category: Physiology Authors: Tags: Am J Physiol Regul Integr Comp Physiol Source Type: research
AbstractPatients with pulmonary hypertension (PH) can be extremely challenging to manage in the critical care setting. In this article we review the classification, diagnosis, and chronic management of PH. An approach to the management of the critically unwell PH patient is discussed. Initial management involves treating underlying precipitants of deterioration and optimizing right ventricular (RV) preload. Reduction of RV afterload with pulmonary vasodilators is also required. Augmentation of cardiac function and perfusion pressures with inotropes and vasopressors may additionally be needed. Advanced renal and respiratory...
Source: Continuing Education in Anaesthesia, Critical Care and Pain - Category: Anesthesiology Source Type: research
Abstract Hypoxic pulmonary vasoconstriction (HPV) is a homeostatic mechanism that is intrinsic to the pulmonary vasculature. Intrapulmonary arteries constrict in response to alveolar hypoxia, diverting blood to better-oxygenated lung segments, thereby optimizing ventilation-perfusion matching and systemic oxygen delivery. In response to alveolar hypoxia, a mitochondrial sensor dynamically changes reactive oxygen species and redox couples in PASMC. This inhibits potassium channels, depolarizes PASMC, activates voltage-gated calcium channels, and increases cytosolic calcium, causing vasoconstriction. Sustained hypox...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Purpose of review: To review the recent insights in the evaluation and management of perioperative (RHF). Recent findings: Recent studies highlight the potential role of myocardial deformation imaging in the evaluation of patients at risk of postoperative RHF. There is also a growing interest to study the value of load-adaptation indices of the right heart in the setting of pulmonary hypertension or left ventricular assist device implantation. Finally, the field of temporary extracorporeal life support devices for RHF is rapidly evolving and new strategies are emerging. Summary: An integrated approach for assessing the car...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: CARDIOVASCULAR ANESTHESIA: Edited by Alexander Zarbock Source Type: research
Purpose of review: The perioperative management of lung transplantation patients remains a challenge. The most important goal is the prevention or attenuation of primary graft failure due to ischemia and reperfusion, operative trauma, and activation of systemic inflammation; it significantly influences short-long and long-term outcome. This review focuses on different aspects regarding the management of these high-risk patients. Recent findings: The Lung Allocation Score was implemented to estimate the survival benefit from a lung transplant. As scarcity of lung grafts persists new techniques such as the ex-vivo lung perfu...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: THORACIC ANESTHESIA: Edited by Thomas Hachenberg and Moritz A. Kretzschmar Source Type: research
ABSTRACT: Vasopressors are gaining renewed interest as treatment adjuncts in hemorrhagic shock. The ideal vasoconstrictor will increase systemic blood pressure without increasing pulmonary vascular resistance (PVR), which hinders pulmonary perfusion and exacerbates hypoxemia. However, the selectivity of pressors for pulmonary versus systemic vasoconstriction during hemorrhage has not been characterized. The purpose of this study was to test the hypothesis that vasopressin (VP) has distinct effects on pulmonary versus systemic hemodynamics, unlike the catecholamine vasopressors norepinephrine (NE) and phenylephrine (PE). An...
Source: Shock - Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Abstract Two mechanisms contribute in the development of pulmonary hypertension in pulmonary embolism (PE) - obstruction of pulmonary blood vessels and vasoconstriction. We hypothesize that hypoxia, increased shear stress and/or activation of gathered leukocytes in the PE may cause a release of reactive oxygen species (ROS). Therefore our aim was to determine the influence of the ROS scavenger Tempol on pulmonary hypertension and to describe NO synthase activity and production of NO oxidative products (NOx) after PE. In general anaesthesia sephadex microspheres suspended in PSS were applied in right jugular vein a...
Source: Physiological Research - Category: Physiology Authors: Tags: Physiol Res Source Type: research
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