Hemodynamics Management

Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock (ECMO-CS) trial

• The ECMO-CS trial was conducted to compare the effects of immediate implementation of VA-ECMO vs. an initially conservative therapy in patients with rapidly deteriorating or severe cardiogenic shock.

• The primary endpoint was the composite of death from any cause, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device at 30 days.

• A total of 122 patients were randomized, and 117 subjects were included in the analysis after excluding 5 patients due to the absence of informed consent.

• The composite primary endpoint occurred in 37 (63.8%) and 42 (71.2%) of patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively (hazard ratio, 0.72; 95% confidence intervals [CI], 0.46 to 1.12; P=0).

Efficacy of Levosimendan in the Treatment of Patients with Severe Septic Cardiomyopathy

www.jcvaonline.com

This study was designed to compare the effects of levosimendan and dobutamine on hemodynamics and clinical efficacy in patients with severe septic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤35%).

•Thirty patients with severe septic cardiomyopathy were enrolled in the study and randomly divided into the levosimendan group and dobutamine group.

• The primary outcome was 28-day mortality.

• At the 24th hour after treatment, the CI, LVEF, SVI, and fluid volume were found to be higher in the levosimendan group than in the dobutamine group.

• On the third day of treatment, cardiac troponin I (cTnI) in the levosimendan group was lower than that in the dobutamine group.

Bedside echocardiography showing severely depressed LV function!

These are the readings from a PA catheter for a patient post lung transplant day 2, Hypotension commenced on Norepinephrine with LA of 6mmol/l. What should you do to improve LA clearance?