ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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We report the case of a 34-year-old woman admitted in our institution for cardiogenic shock related to acute myocarditis. Initial hemodynamic instability required mechanical ventilation and peripheral venoarterial extracorporeal membrane oxygenation (ECMO). ⋯ The clinical situation quickly worsened, and the patient finally died. This case highlights the usefulness of Impella pump to unload left cardiac chambers but also its technical challenge when used in a patient on ECMO.
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Review Case Reports
Use of extracorporeal respiratory support during pregnancy: a case report and literature review.
We describe the case of a 25 year-old woman at 27 weeks of gestation who was admitted to our intensive care unit (ICU) for acute respiratory distress syndrome (ARDS) caused by pandemic 2009 H1N1 influenza A. She presented with septic shock and refractory hypoxemia unresponsive to rescue therapies such as recruitment maneuvers, prone positioning, and nitric oxide inhalation. ⋯ No fetal complications were observed. At 38 weeks of gestation she gave birth to a healthy baby.
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Randomized Controlled Trial
Clinical validation of a real-time data processing system for cardiac output and arterial pressure measurement during intraoperative biventricular pacing optimization.
Biventricular pacing (BiVP) improves cardiac output (CO) and mean arterial pressure (MAP) after cardiopulmonary bypass (CPB) in selected patients at risk for acute left heart failure after cardiac surgery. Optimization of atrioventricular delay (AVD) and interventricular delay (VVD) to maximize the hemodynamic effect of pacing requires rapid and accurate data processing. Conventional post hoc data processing (PP) is accurate but time-consuming, and infeasible in the intraoperative setting. ⋯ Interexaminer reliability coefficient values ranged from 0.997 to 0.999, indicating RTP is as reliable as PP for optimization. Real-time data processing is instantaneous and therefore is more practical in a clinical setting than the PP method. Real-time data processing is useful for guiding intraoperative BiVP optimization and merits further development.
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Myocarditis may result in cardiogenic shock, and when medical therapy is unable to maintain adequate cardiac output, mechanical circulatory support is indicated. This is the first reported case of a percutaneous left ventricular assist device being used in combination with extracorporeal membrane oxygenation in a patient with biventricular and respiratory failure, as a bridge to recovery.
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Device-related hemolysis leading to anemia is a recognized chronic complication of a left ventricular assist device (LVAD). With the increased usage of the LVAD in the management of end-stage heart failure, an increased number of complications are being recognized. We present a case where a combination of elevated mean arterial pressure and development of aortic regurgitation resulted in increased hemolysis, power spikes, and anemia, mimicking device thrombus, resulting in a diagnostic dilemma.