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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Dynamic Extracorporeal Life Support in a Patient With Left Ventricular Assist Device and Electrical Storm: A Case
Joseph Michael Brewer1,2, Obaid Ashraf1, Jordan Phillips1
1From the INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, Oklahoma City, Oklahoma.
Abstract:
Left ventricular assist device (LVAD)-supported patients experiencing electrical storm (ES) and cardiac arrest present unique management challenges. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is commonly used for extracorporeal cardiopulmonary resuscitation (ECPR), but its application in LVAD-supported patients presents hemodynamic complexities. Alternative ECMO modes, including venopulmonary (VP) and hybrid venoarteriopulmonary (VAP) ECMO, may provide tailored circulatory and respiratory support in select cases. This case report describes a patient with a newly implanted LVAD who developed ES, refractory right ventricular failure, and cardiac arrest. The patient underwent staged ECMO support, transitioning from VA ECMO for ECPR to hybrid VAP ECMO and ultimately to VP ECMO, based on evolving hemodynamic needs.
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