Dirk Vlasselaers1, Matthias Desmet2, Lars Desmet2, Bart Meyns3, Joseph Dens4. 1. Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. dirk.vlasselaers@uz.kuleuven.ac.be. 2. Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. 3. Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. 4. Department of Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
Abstract
OBJECTIVE: ECMO for acute cardiorespiratory failure is an established therapeutic option. Persistent insufficient unloading of the left ventricle (LV) can compromise recovery of ventricular function. We decided to insert a miniature rotary blood pump (Impella) for decompression of the LV. In contrast to previous experience with this new device, where it was generally used for postcardiotomy heart failure or cardiogenic shock and inserted in the operating room or the catheter laboratory, this is the first report describing the potential of this technology in the intensive care unit, in a patient on ECMO and the value of echocardiography guidance. PATIENT: A 13-year-old boy with a history of congenital heart disease was admitted to the ICU with acute cardio-respiratory failure. INTERVENTIONS: On day 2 venoarterial ECMO was instituted because of worsening cardiorespiratory insufficiency refractory to conventional treatment. On day 5 a percutaneous rotary blood pump was inserted to decompress the LV. CONCLUSIONS: A percutaneous miniature rotary blood pump can be an alternative to decompress a failing LV in the setting of VA-ECMO. Echocardiography can avoid the use of fluoroscopy and the transport to a catheter laboratory to insert the rotary pump.
OBJECTIVE: ECMO for acute cardiorespiratory failure is an established therapeutic option. Persistent insufficient unloading of the left ventricle (LV) can compromise recovery of ventricular function. We decided to insert a miniature rotary blood pump (Impella) for decompression of the LV. In contrast to previous experience with this new device, where it was generally used for postcardiotomy heart failure or cardiogenic shock and inserted in the operating room or the catheter laboratory, this is the first report describing the potential of this technology in the intensive care unit, in a patient on ECMO and the value of echocardiography guidance. PATIENT: A 13-year-old boy with a history of congenital heart disease was admitted to the ICU with acute cardio-respiratory failure. INTERVENTIONS: On day 2 venoarterial ECMO was instituted because of worsening cardiorespiratory insufficiency refractory to conventional treatment. On day 5 a percutaneous rotary blood pump was inserted to decompress the LV. CONCLUSIONS: A percutaneous miniature rotary blood pump can be an alternative to decompress a failing LV in the setting of VA-ECMO. Echocardiography can avoid the use of fluoroscopy and the transport to a catheter laboratory to insert the rotary pump.
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