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A randomized embedded multifactorial adaptive platform for extra corporeal membrane oxygenation (REMAP ECMO) - design and rationale of the left ventricular unloading trial domain.
Am Heart J
January 2025
Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address:
Article Synopsis
- ECMO (Extracorporeal Membrane Oxygenation) has high complication rates, prompting the need for improved management strategies, which led to the development of the REMAP ECMO platform to investigate effective patient management techniques.* -
- The REMAP ECMO platform allows for multiple adaptive randomized controlled trials, with the first focusing on the effects of early left ventricular unloading via intra-aortic balloon pumping compared to ECMO alone for cardiogenic shock patients in the ICU.* -
- The primary outcome aims to determine successful weaning from ECMO at 30 days, while secondary outcomes include intervention needs, survival rates, and quality of life, all analyzed using a flexible Bayesian statistical framework.*
Hemodynamic Response after Intra-aortic Balloon Counter-Pulsation in Cardiac Amyloidosis and Cardiogenic Shock.
J Card Fail
October 2024
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kauffman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, Cleveland, Ohio. Electronic address:
Article Synopsis
- In patients with heart failure-related cardiogenic shock due to cardiac amyloidosis, using an intra-aortic balloon pump (IABP) may enhance hemodynamic stability and support their transition to advanced therapies like heart transplants.
- A study reviewed 23 patients with cardiac amyloid who received IABP and found a 1-year survival rate of 74%, with 65% of them progressing to heart transplants.
- The use of IABP notably increased mean arterial pressure and cardiac indices while decreasing various pressures related to heart function, indicating significant improvement in their cardiovascular status.
Early outcomes in heart transplantation using donation after circulatory death donors in patients bridged with durable left ventricular assist devices.
J Thorac Cardiovasc Surg
September 2024
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY. Electronic address:
Article Synopsis
- Donation after circulatory death heart transplantation may expand donor options, particularly benefiting patients with lower urgency status who are using durable left ventricular assist devices (LVADs).
- A study analyzed data from the United Network for Organ Sharing between 2019 and 2022, comparing outcomes of heart transplant recipients with LVADs to those receiving other bridging support, focusing on one-year mortality and several medical complications.
- While the one-year mortality rates showed no significant difference, patients with LVADs experienced higher rates of acute rejection, suggesting the need for careful monitoring and management post-transplant.
Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America.
Am Heart J
October 2024
Northwell, New Hyde Park, Cardiovascular Institute, NY; Lenox Hospital, Northwell Health, New York, New York; Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address:
Article Synopsis
- The study investigates current management practices for patients using temporary mechanical circulatory support (tMCS) devices like intra-aortic balloon pumps and Impella in North American cardiac intensive care units.
- An online survey was conducted, with a response rate of 84% from 37 centers, focusing on hemodynamic monitoring, hemocompatibility, and weaning/removal of the devices.
- Results showed significant variability in how these practices are implemented, indicating a need for standardized guidelines to improve patient outcomes with tMCS.
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