Mechanical circulatory support in high-risk PCI and acute coronary syndrome

Joint Authors

Pappalardo, Federico
Ruggeri, Laura

Source

Qatar Medical Journal

Publisher

Hamad Medical Corporation

Publication Date

2017-06-30

Country of Publication

Qatar

No. of Pages

2

Main Subjects

Medicine

Topics

• Patients
• Heart
• Catheterization
• Diagnosis
• Acute coronary syndrome

English Abstract

Acute myocardial infarction is a common cause of cardiogenic shock (approximately 75% of all patients) and out-of-hospital cardiac arrest (approximately 70% of survivors).1 Mechanical hemodynamic support is employed prior to coronary revascularization (pre-percutaneous coronary intervention (PCI)), during or after PCI.2 Revascularization procedure is characterized by a transient interruption of coronary blood flow (due to repetitive contrast dye injections, balloon inflations, atherectomy passes, and stent manipulations) resulting in a negative inotropic effect.

Percutaneous left ventricular assist device implantation (Impella and TandemHeart), and intra-aortic balloon pump implantation have been described as strategies to avoid the worsening of cardiac function during PCI in the literature, especially in high-risk patients.

The USpella registry has shown that pre-PCI implantation of IMPELLA 2.5 significantly improves survival of cardiogenic shock patients (Figure 1).3 Cardiac arrest is a recognized complication in the cath lab during percutaneous procedures, such as valve interventions, left auricle closure, and vascular interventions in addition to PCI.

Extracorporeal cardiopulmonary resuscitation (ECPR) in terms of VA-ECMO plays a role in rescue therapy for cardiac arrest4 with a better outcome, when compared with conventional cardiopulmonary resuscitation (CPR), when CPR is failing.5 However, the technical and logistical possibility to implement ECPR in the cath lab is challenging.

First, to deal with an emergency strategy out of intensive care and operative theater.

In this context, trained personnel and dedicated sets of instruments and drugs could play a role.

Second, the fluoroscope limits the free access to the patient.

Moreover, percutaneous VA-ECMO cannulation requires a complex approach as the vascular accesses have been violated in most cases during the procedure.

On the other hand, the presence of a multidisciplinary team has to be considered as an important resource.

In conclusion, an adequate cardiac support during cath lab procedures should be planned whenever possible to avoid emergencies especially in high-risk patients.

Training and local protocols should be provided to overcome the procedural difficulties of ECPR.

Data Type

Conference Papers

Record ID

BIM-789695

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