Utilization of Shock Team and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in the Management of Cardiogenic Shock in Northern Ontario.

Autor:	Alnasser S; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Cavanagh M; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Atoui R; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiac Surgery, Sudbury, Ontario, Canada., Ali N; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Nalla B; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., McKechnie K; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Main A; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., Rheault-Henry M; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Al-Shaibi A; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Burke L; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., McIsaac S; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Anderson R; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Fam N; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., Shurrab M; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., Kerr MC; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada., Hennessey H; Division of Radiology, Health Sciences North, Sudbury, Ontario, Canada., Armstrong C; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada., Bittira B; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiac Surgery, Sudbury, Ontario, Canada., Alqahtani A; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., Papadopoulos G; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., Kumar A; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.; Division of Cardiology, Health Sciences North, Sudbury, Ontario, Canada., MacDonald D; Division of Cardiac Surgery, Sudbury, Ontario, Canada., O'Connor C; Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada., McDonald M; Division of Cardiology, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada., Manchuk D; Division of Critical Care, Health Sciences North, Sudbury, Ontario, Canada.; Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	CJC open [CJC Open] 2023 Oct 03; Vol. 6 (1), pp. 47-53. Date of Electronic Publication: 2023 Oct 03 (Print Publication: 2024).
DOI:	10.1016/j.cjco.2023.09.019
Abstrakt:	Background: Despite advancements in critical care and coronary revascularization, cardiogenic shock (CS) outcomes remain poor. Implementing a shock team and use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have been associated with improved CS outcomes, but its feasibility in remote and rural areas remains unknown. Methods: This retrospective study included patients with CS who required mechanical circulatory support (MCS) at Health Sciences North, Sudbury, Ontario. The analysis aimed to accomplish 2 objectives: first, to review the outcomes associated with use of Impella (Abiomed, Danvers, MA) and, second, to assess the feasibility of establishing a shock team to facilitate the local implementation of VA-ECMO. The primary endpoint was in-hospital mortality. Results: The outcomes of 15 patients with CS who received Impella between 2015 and 2021 were reviewed. Their average age was 65 years (standard deviation [SD]: 13), and 8 patients (53%) were female. CS was ischemic in 12 patients (80%). Transfemoral Impella CP (cardiac power) was the most frequently used (93%). Thirteen patients (87%) died during the index hospital stay post-Impella because of progressive circulatory failure. The shock team was established following consultations with several Canadian MCS centres, leading to the development of a protocol to guide use of MCS. There have been 4 cases in which percutaneous VA-ECMO using Cardiohelp (Getinge/Maquet, Wayne, NJ) has been used; 3 (75%) survived beyond the index hospitalization. Conclusions: This analysis demonstrated the feasibility of implementing a shock team in remote Northern Ontario, enabling the use of VA-ECMO with success in a centre with a sizeable rural catchment area. This initiative helps address the gap in cardiac care outcomes between rural and urban areas in Ontario. (© 2023 The Authors.)
Databáze:	MEDLINE
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