SCCM Resource Library-Extracorporeal Membrane Oxygenation: Mechanical Circulatory Support for Cardiogenic Shock: Past, Present and Future

Video Transcription

Video Summary

Dr. Saras Chandra Vallabha Josula, an interventional and critical care cardiologist at Wake Forest University School of Medicine, discusses extracorporeal membrane oxygenation (ECMO) in the context of cardiogenic shock. Cardiogenic shock is a state of ineffective cardiac output primarily due to a cardiac disorder, resulting in poor tissue perfusion. Dr. Josula discusses the different phenotypes of cardiogenic shock and the stages of shock classification developed by the Society of Cardiovascular and Geography and Intervention. He highlights the increasing prevalence of cardiogenic shock and the use of mechanical circulatory support devices such as ECMO, Impella, and balloon pumps. He emphasizes the importance of LV unloading in ECMO patients and the potential complications associated with ECMO use. Dr. Josula also emphasizes the need for a clear exit strategy when using ECMO and the importance of considering palliative care in patients with acute myocardial infarction and cardiogenic shock.

Asset Subtitle

Cardiovascular, Procedures, 2022

Asset Caption

Cardiogenic shock after acute myocardial infarction requires immediate resuscitative therapy to prevent irreversible organ damage. Mortality, although decreased significantly, remains high. Intensivists more frequently encounter patients with cardiogenic shock. The key to a good outcome is an organized approach, with rapid recognition and prompt initiation of therapy to improve hemodynamics, tissue perfusion, ventilatory support, and reversal of the underlying cause. The concept of establishing ventricular support before revascularization stresses the notion that unloading the left ventricle is key to its recovery. Different percutaneous devices for mechanical support have different effects on left ventricular afterload and myocardial oxygen demand. An understanding of the advantages and disadvantages of these devices helps the clinician select the right device in the right setting.

Meta Tag

Content Type Presentation

Knowledge Area Cardiovascular

Knowledge Area Procedures

Knowledge Level Advanced

Learning Pathway Cardiothoracic Critical Care

Membership Level Select

Tag Shock

Tag Extracorporeal Membrane Oxygenation ECMO

Tag Cardiothoracic Critical Care

Year 2022

Keywords

ECMO

cardiogenic shock

LV unloading

mechanical circulatory support

complications

palliative care

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