nverted tako-tsubo cardiomyopathy (ITC) is a variation of stress cardiomyopathy. It features transient myocardial dysfunction characterised by a typical contractile abnormality consisting of extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. Endogenous and esogenous catecholamine surges are believed to be the mediators of this potentially life-threatening condition. We report for the first time in this setting with refractory cardiogenic shock, the use of ECLS treatment in order to unload the heart, sustain circulation and end-organ perfusion, and promote ventricular recovery. METHODS:From June 2008 to December 2011 we treated 4 adult polytrauma patients (mean age: 32,7+/-23,3 years, mean ISS score 59,7+/-13,4) with veno-arterial (v-a) ECLS for refractory cardiopulmonary failure and cardiac arrest due to ITC. We used a miniaturised ECLS device (PLS-Set, MAQUET Cardiopulmonary AG, Hechingen, Germany) and performed initially heparin-free ECMO. RESULTS:Prior to ECMO median pH was 7.12+/-0.14 (6.91-7,25), median lactate was 6.7+/-2.8 (10-4) mmol/l and median norepinephrine demand was 6.8 (3.5-19.6) mg/h. Refractory cardiopulmonary failure and CA complicating ITC was treated effectively with ECLS and perfusion parameters and blood flow improved rapidly within 4 h on ECLS in all patients and permits inotropic drugs weaning. 2 patients had recovered completely and 2, after post-traumatic cerebral dead determination, underwent organs explantation (ECLS as "Bridge to organs donation"). CONCLUSIONS:Initially heparin-free ECLS support can improve therapy and outcome even in disastrous polytrauma patients with coexisting/potential bleeding status and severe refractory myocardial dysfunction. Extra-corporeal life support allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery.

Refractory Inverted Takotsubo Cardiomyopathy in polytraumatized patients: clinical features and advanced treatment / Massimo Bonacchi; Rosario Spina; Leonardo Torracchi; Gabriella Di Lascio; Guy Harmelin; Adriano Peris; Guido Sani. - STAMPA. - 1:(2012), pp. 345-349. (Intervento presentato al convegno 8th Congress of Update in Cardiology and Cardiovascular Surgery Congress tenutosi a Antalya, Turkey nel 1-4/3/2012).

Refractory Inverted Takotsubo Cardiomyopathy in polytraumatized patients: clinical features and advanced treatment

BONACCHI, MASSIMO
;
SANI, GUIDO
2012

Abstract

nverted tako-tsubo cardiomyopathy (ITC) is a variation of stress cardiomyopathy. It features transient myocardial dysfunction characterised by a typical contractile abnormality consisting of extensive left ventricular circumferential dyskinesia or akinesia with a hyperkinetic apex. Endogenous and esogenous catecholamine surges are believed to be the mediators of this potentially life-threatening condition. We report for the first time in this setting with refractory cardiogenic shock, the use of ECLS treatment in order to unload the heart, sustain circulation and end-organ perfusion, and promote ventricular recovery. METHODS:From June 2008 to December 2011 we treated 4 adult polytrauma patients (mean age: 32,7+/-23,3 years, mean ISS score 59,7+/-13,4) with veno-arterial (v-a) ECLS for refractory cardiopulmonary failure and cardiac arrest due to ITC. We used a miniaturised ECLS device (PLS-Set, MAQUET Cardiopulmonary AG, Hechingen, Germany) and performed initially heparin-free ECMO. RESULTS:Prior to ECMO median pH was 7.12+/-0.14 (6.91-7,25), median lactate was 6.7+/-2.8 (10-4) mmol/l and median norepinephrine demand was 6.8 (3.5-19.6) mg/h. Refractory cardiopulmonary failure and CA complicating ITC was treated effectively with ECLS and perfusion parameters and blood flow improved rapidly within 4 h on ECLS in all patients and permits inotropic drugs weaning. 2 patients had recovered completely and 2, after post-traumatic cerebral dead determination, underwent organs explantation (ECLS as "Bridge to organs donation"). CONCLUSIONS:Initially heparin-free ECLS support can improve therapy and outcome even in disastrous polytrauma patients with coexisting/potential bleeding status and severe refractory myocardial dysfunction. Extra-corporeal life support allowed inotropic drug weaning while maintaining end-organ function and supported the patient until myocardial recovery.
2012
Acts of 8th Congress of Update in Cardiology and Cardiovascular Surgery Congress
8th Congress of Update in Cardiology and Cardiovascular Surgery Congress
Antalya, Turkey
1-4/3/2012
Massimo Bonacchi; Rosario Spina; Leonardo Torracchi; Gabriella Di Lascio; Guy Harmelin; Adriano Peris; Guido Sani
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/600411
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