CC BY-NC-ND 4.0 · Journal of Cardiac Critical Care TSS 2022; 06(03): 185-189
DOI: 10.1055/s-0042-1759861

ECMO and Ventricular Assist Devices as a Bridge to Transplant

Poonam Malhotra Kapoor
1   Department of Cardiac Anaesthesia and Critical Care, AIIMS, New Delhi, India
› Author Affiliations

Heart Failure Management

Many cardiac diseases, like coronary artery disease and some viral cardiomyopathy over a period of time, give rise to the condition called heart failure (HF). More than 2 million Indians suffer from HF today. The first line of management includes lifestyle modifications, as well as medical therapy. The latter uses drugs such as beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptors/blockers aldosterone antagonists, diuretics, digoxin, and many others keep getting added with more research and research and development today. Salt and fluid restriction too plays a pivotal role. Patients with a wide QRS complex in their electrocardiogram and those having a moderate to severe symptoms of HF need to have a cardiac resynchronization therapy and a patient with fatal arrhythmias needs an implantable defibrillator inserted as therapy. So, use of advanced mechanical therapies is a necessity in HF patient.

Most HF Indians have class III or class IV symptoms of dyspnea at rest of some duration or a recent origin. In this scenario of advanced mechanical support in HF patient, the two definitive therapies of nearly 6,000 in number and still on the increase are the use of ventricular assist devices (VAD) and heart transplant, which have met with some success ([Box 1]). This editorial briefly revises extracorporeal membrane oxygenation (ECMO) as a bridge to transplant ([Figs. 1] and [2]).

Box 1

Integrated ECMO circuit: clinical uses and benefits—AIIMS experience

• Integrated ECMO circuitry was established along with CPB circuit and primed with blood

• Advantages of integrated circuit of them:

 1. No time is lost from decision to initiation of ECMO

 2. Early Initiation may prevent end organ damage

 3. With a use of integrated ECMO, surgical asepsis is maintained

 4. The procedure is cost-effective

 5. Increasing survival in these critically ill patients

Abbreviations: CPB, cardiopulmonary bypass; ECMO, extracorporeal membrane oxygenation.

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Fig. 1 Mechanical assist devices in heart failure patients. (Adapted with permission and courtesy to Jaypee Publishers, New Delhi, Manual of ECMO in ICU 2018, 2nd ed.) ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; LVAD, left ventricular assist device.
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Fig. 2 The typical extracorporeal membrane oxygenation (ECMO) circuit.

Extracorporeal Membrane Oxygenation

ECMO is used in cardiac or pulmonary failure in moribund patients, wherein supraoptimal medical therapy does not work at all ([Figs. 3A] and [B]). Venovenous ECMO provides adequate oxygenation and carbon dioxide removal in isolated refractory respiratory failure, while venoarterial (VA) ECMO when support is required for cardiac and/or respiratory failure.[1]

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Fig. 3 Choice of extracorporeal membrane oxygenation (ECMO) in different clinical scenarios.


Publication History

Article published online:
03 December 2022

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