Page 40 - ANZCP Gazette MAY 2014

ECLS DURING PCI AND TAVI PROCEDURES Matthias Arlt1 MD, Alois Philipp2 ECCP, Bernhard M. Graf3 MD, PhD, Christof Schmid2 MD, PhD,
Christian Hengstenberg4 MD, PhD and Michael Hilker2 MD, PhD
1Kerckhoff Heart and Lung Centre, Dept. of Anesthesiology and Intensive Care 2University Hospital Regensburg, Dept. of Cardiothoracic Surgery 3University Hospital Regensburg, Dept. of Anesthesiology
4German Heart Centre Munich, Dept. of Cardiology, Germany
Research was carried out at University Hospital Regensburg, Germany
Dept. of Anesthesiology and Intensive Care
Kerckhoff Heart and Lung Centre, 1Benekestr. 2-8, D-61231 Bad Nauheim, Germany
Background
Cardiocirculatory arrest during percutaneous coronary interventions (PCI) or transcatheter aortic valve implantation (TAVI) requires mechanical cardio-pulmonary resuscitation (CPR) to restore spontaneous circulation. Mechanical CPR leads to interruption of the procedure and can compromise the success of the intervention. Extracorporeal life support (ECLS) can replace mechanical chest compression during CPR and therefore be highly effective.
Method
Patients with refractory cardiocirculatory arrest during PCI and TAVI procedures where treated with percutaneous femoro- femoral ECLS using two different types of miniaturized ECLS systems. Both systems can be hand-held and act independently from wall connection points for oxygen and power supply.
Findings
Between 2006 and 2011 we treated 14 patients with percutaneous ECLS during PCI (n=10) and TAVI (n=4) procedures. On ECLS, beating heart circulation could be restored in all patients, mechanical chest compression was not necessary. The interventional procedures could be successfully completed in all PCI and two TAVI patients. Two TAVI patients were bridged on ECLS to surgical aortic valve replacement. In total, hospital survival rate was 50%.
Conclusion
The use of miniaturized, hand-held ECLS systems enables extra-corporeal resuscitation support (E-CPR) easily and rapidly in PCI and TAVI patients. Blood flow and gas exchange can be restored effectively without disturbance by mechanical chest compression. However, severe vessel damage limits the use of miniaturized closed-loop ECLS systems.
1. Arlt M., Philipp A., Voelkel S, et. al. Early experiences with miniaturized extracorporeal life support in the catheterization laboratory. Eur J Cardiothorac Surg 2012;0:1-6
ASIA PACIFIC ELSO AND THE RED BOOK A/Prof Graeme MacLaren
National University Heart Centre, Singapore
APELSO
Following the formation of a European Chapter of ELSO in 2012, a group of individuals in the Asia-Pacific region decided to create a comparable chapter in the Far East and Oceania. With the support of the then Chair of ELSO, the Chapter was formed and had its inaugural meeting in Beijing in October, 2013. A summary of the Chapter’s achievements, structure, vision, and goals will be highlighted.
Red Book
In 2012, the fourth edition of the ‘Red Book’ was published. This text is generally regarded as the standard text of ECMO and is published periodically by ELSO. The speaker had the privilege of being invited as a senior editor for the fourth edition. The structure, content and contributors to the book will be discussed, alongside ELSOs larger vision for the global dissemination of ECMO.
38 MAY 2014 | www.anzcp.org