Mechanical Cardiopulmonary Support Research Articles

CONTINUOUS LEFT STELLATE GANGLION BLOCK DURING VT ABLATION TO SLOW VT AND IMPROVE ABLATION OUTCOME

Abstract Introduction Perioperative management of advanced patients with indication to ventricular tachycardia (VT) ablation is complex. A PAINESD score ≥ 15 was proposed to identify those who might benefit from pre–emptive mechanical cardiopulmonary support (MCS). We present a case successfully managed with continuous percutaneous left stellate ganglion block (C–PLSGB). Case A 71–year–old diabetic man with severe post–ischemic cardiomyopathy (LVEF 24%, NYHA Class III) and chronic pulmonary disease was admitted for electrical storm with multiple ICD shocks due to poorly tolerated monomorphic VT (MMVT) at 176 bpm resistant to anti–tachycardia pacing (ATP), despite ongoing chronic oral therapy with amiodarone and carvedilol. Poorly tolerated and ATP–resistant MMVTs at 170–180 bpm recurred despite intravenous (iv) amiodarone and lidocaine (20 mcg/kg/min) and oral propranolol. Ultrasound guided C–PLSGB was therefore started; lidocaine was chosen for the continuous infusion due to the short half–life, at the initial dose of 10 mg/h; 6 hours later, his poorly tolerated MMVT recurred at 167 bpm. Therefore, at first we increased iv lidocaine to 30 mcg/kg/min, without benefit, then we increased C–PLSGB at 37.5 mg/h and decreased iv lidocaine to 20 mcg/kg/min due to neurological symptoms. With this regimen, the patient stayed VT free for 2 hours, then the clinical VT recurred at 130 bpm, with good hemodynamic tolerability and ATP–response. C–PLSGB infusion was than increased to 75 mg/h, with no more VT. Endocardial VT ablation was planned. Despite a very high PAINESD score (31) we decided to avoid pre–emptive MCS. We stopped lidocaine (both iv and as C–PLSGB) 2 hours before ablation. As soon as the patient came in the EP room (before instrumentation), the clinical MMVT recurred at 133 bpm. C–PLSGB was then resumed (initially at 100 mg/h for 30 minutes, then at 37.5 mg/h). The MMVT then spontaneously recurred at 133 bpm: it was mapped and ablated in the medio–apical anterior wall, with acute VT interruption. A second VT morphology then appeared, that was mapped and ablated at a more basal site, despite a partial epicardial component of the circuit was identified. C–PLSGB was then stopped and no more VT occurred nor were induced 1 hour later. At 8 months the patient is still alive with no more VT. Conclusion C–PLSGB with individually tailored infusion rates could be used during VT ablation as a mean to reduce VT cycle length and allow for mapping without MCS.

Subtypes and Mechanistic Advances of Extracorporeal Membrane Oxygenation-Related Acute Brain Injury.

Extracorporeal membrane oxygenation (ECMO) is a frequently used mechanical cardiopulmonary support for rescuing critically ill patients for whom conventional medical therapies have failed. However, ECMO is associated with several complications, such as acute kidney injury, hemorrhage, thromboembolism, and acute brain injury (ABI). Among these, ABI, particularly intracranial hemorrhage (ICH) and infarction, is recognized as the primary cause of mortality during ECMO support. Furthermore, survivors often suffer significant long-term morbidities, including neurocognitive impairments, motor disturbances, and behavioral problems. This review provides a comprehensive overview of the different subtypes of ECMO-related ABI and the updated advance mechanisms, which could be helpful for the early diagnosis and potential neuromonitoring of ECMO-related ABI.

A case of pediatric out-of-hospital cardiac arrest due to fulminant myocarditis requiring extracorporeal cardiopulmonary resuscitation

A 7-year-old girl presented with a 2-day history of fever and chest pain that led her to collapse, prompting her father to call the emergency medical services (EMS). Both an EMS ambulance and a physician-staffed ambulance were dispatched to the scene. Upon arrival, the EMS crew discovered that the patient was in cardiac arrest, with ventricular fibrillation (VF) as the initial heart rhythm. Due to the patient’s refractory VF, the physician requested the receiving hospital to prepare for extracorporeal cardiopulmonary resuscitation (ECPR), which was successfully initiated 105 minutes after the patient’s collapse. The patient was admitted to the intensive care unit, where her cardiac function gradually improved. On the eighth day, she was successfully weaned off extracorporeal membrane oxygenation and discharged from the hospital on the thirty-third day without any neurological complications. The presumed cause of the cardiac arrest was fulminant myocarditis, based on the patient’s clinical history and findings from cardiac magnetic resonance imaging. Overall, early mechanical cardiopulmonary support is crucial for patients with fulminant myocarditis. However, cases resulting in out-of-hospital cardiac arrest generally have poor outcomes, even with ECPR. This particular case demonstrated that optimal resuscitation, spanning from the prehospital phase to the intensive care unit, utilizing ECPR, played a vital role in achieving a favorable neurological outcome.

CATASTROPHIC PULMONARY EMBOLISM SUCCESSFULLY TREATED WITH EXTRACORPOREAL MEMBRANE OXYGENATION

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) is increasingly recognized as a modality for cardiopulmonary support in high-risk pulmonary embolism (PE). We report a successful application of VA ECMO to support a patient following cardiac arrest secondary to massive saddle PE. CASE PRESENTATION: A 35 year old woman was admitted with new cranial nerve palsies, concerning for neurosarcoidosis versus lymphoma. On hospital day (HD) 11 she became dyspneic and desaturated to 88% on room air; other vitals remained stable. CT chest revealed bilateral pulmonary artery occlusion with right heart strain. NT-proBNP was 3086 pg/mL (ref <125). Multidisciplinary Pulmonary Embolism Response Team (PERT) stratified her as "intermediate-high risk" PE, and recommended therapeutic heparin infusion, with resultant clinical improvement. On HD16 she developed acute chest pain with new tachycardia (HR 130), hypotension (BP 87/65) and increased oxygen requirements. S1Q3T3 pattern was noted on EKG. PE Severity Index (PESI) was 125 (Class IV), and PERT elected for urgent catheter-directed thrombectomy. Prior to procedure she suffered a cardiac arrest, and received ACLS plus systemic thrombolytics, with return of spontaneous circulation after 20 minutes. Post-arrest suction thrombectomy removed large clot burden, but with persistent hypotension despite inhaled nitric oxide, vasopressor and inotropic support and severe right ventricle (RV) systolic dysfunction on echocardiogram, she was peripherally cannulated for VA-ECMO. Her ECMO course was complicated by renal failure requiring renal replacement therapy and hemoperitoneum requiring blood transfusion. Vasopressors were weaned off on ECMO day 4, and she was decannulated on ECMO day 6. She was discharged on HD42, neurologically intact and with recovered cardiac and renal function. DISCUSSION: High-risk PE, defined by acute PE with hemodynamic instability, shock, or cardiac arrest, is associated with high mortality. VA ECMO allows for maintenance of organ perfusion and oxygenation by mechanically bypassing and decompressing the failing RV and pulmonary circulation, offering hemodynamic and respiratory support to allow for reperfusion strategies or spontaneous thrombolysis on heparin. ECMO is increasingly available, with mobile teams allowing for rapid deployment. The literature on ECMO as a rescue therapy for catastrophic PE is limited to small case series, and recent meta analyses were unable to draw definitive conclusions (1, 2). 2019 European guidelines suggest that mechanical cardiopulmonary support may be helpful for high-risk PE with circulatory collapse (3). CONCLUSIONS: This case adds to reports of successful use of VA-ECMO for high-risk PE. Early ECMO consultation and timely appropriate use may prevent sudden cardiac death. Further research is needed to determine what role ECMO may play as an early intervention rather than a salvage procedure. REFERENCE #1: Pozzi, Matteo, et al. "Efficacy and safety of extracorporeal membrane oxygenation for high-risk pulmonary embolism: A systematic review and meta-analysis." Vascular Medicine 25.5 (2020): 460-467. REFERENCE #2: Baldetti, Luca, et al. "Use of extracorporeal membrane oxygenation in high-risk acute pulmonary embolism." Artificial Organs (2020). REFERENCE #3: Konstantinides, Stavros V., et al. "2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS) The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)." European heart journal 41.4 (2020): 543-603. DISCLOSURES: no disclosure on file for Stephanie Nonas; No relevant relationships by Jonathan Taylor, source=Web Response

Efficacy of theories related to extracorporeal life support specialist assisting client during the COVID-19 pandemic

As the wave of respiratory and cardiac failure due to an unprecedented pandemic hits our medical centers, extracorporeal life support (ECLS) specialists have become more involved with long term intensive care; our relationship to patient care has been altered. ECLS and Ventricular Assist Devices (VAD) have become essential tools in the care of critically ill patients with respiratory failure, post-cardiotomy failure, and viral infection. During this unprecedented pandemic, there have been many advancements and rapid growth towards options of long term mechanical cardiopulmonary support, especially in the adult patient population. ECLS cases reported to the International Extracorporeal Life Support Organization registry, showing &gt;73,000 patients. With the growth of this patient population and the changing “ECLS specialist-Patient” family relationship, it is essential to explore handling the grief of the patients. Individuals dealing with pain demonstrate a variety of reactions as they adjust to a life without a loved one. This review examines the efficacy of theories related to ECLS specialists, assisting a client, and families grieving the loss of a significant person in their life.

Left Pulmonary Artery Ligation and Chronic Pulmonary Artery Banding Model for Inducing Right Ventricular-Pulmonary Hypertension in Sheep.

Pulmonary hypertension (PH) is a progressive disease that leads to cardiopulmonary dysfunction and right heart failure from pressure and volume overloading of the right ventricle (RV). Mechanical cardiopulmonary support has theoretical promise as a bridge to organ transplant or destination therapy for these patients. Solving the challenges of mechanical cardiopulmonary support for PH and RV failure requires its testing in a physiologically relevant animal model. Previous PH models in large animals have used pulmonary bead embolization, which elicits unpredictable inflammatory responses and has a high mortality rate. We describe a step-by-step guide for inducing pulmonary hypertension and right ventricular hypertrophy (PH-RVH) in sheep by left pulmonary artery (LPA) ligation combined with progressive main pulmonary artery (MPA) banding. This approach provides a controlled method to regulate RV afterload as tolerated by the animal to achieve PH-RVH, while reducing acute mortality. This animal model can facilitate evaluation of mechanical support devices for PH and RV failure.

Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO-a Living Working Document.

The severe acute respiratory syndrome-CoV-2 is an emerging viral pathogen responsible for the global coronavirus disease 2019 pandemic resulting in significant human morbidity and mortality. Based on preliminary clinical reports, hypoxic respiratory failure complicated by acute respiratory distress syndrome is the leading cause of death. Further, septic shock, late-onset cardiac dysfunction, and multiorgan system failure are also described as contributors to overall mortality. Although extracorporeal membrane oxygenation and other modalities of mechanical cardiopulmonary support are increasingly being utilized in the treatment of respiratory and circulatory failure refractory to conventional management, their role and efficacy as support modalities in the present pandemic are unclear. We review the rapidly changing epidemiology, pathophysiology, emerging therapy, and clinical outcomes of coronavirus disease 2019; and based on these data and previous experience with artificial cardiopulmonary support strategies, particularly in the setting of infectious diseases, provide consensus recommendations from American Society for Artificial Internal Organs. Of note, this is a living document, which will be updated periodically, as additional information and understanding emerges.

Advanced Pulmonary and Cardiac Support of COVID-19 Patients: Emerging Recommendations From ASAIO-A "Living Working Document".

The severe acute respiratory syndrome (SARS)-CoV-2 is an emerging viral pathogen responsible for the global coronavirus disease 2019 (COVID)-19 pandemic resulting in significant human morbidity and mortality. Based on preliminary clinical reports, hypoxic respiratory failure complicated by acute respiratory distress syndrome is the leading cause of death. Further, septic shock, late-onset cardiac dysfunction, and multiorgan system failure are also described as contributors to overall mortality. Although extracorporeal membrane oxygenation and other modalities of mechanical cardiopulmonary support are increasingly being utilized in the treatment of respiratory and circulatory failure refractory to conventional management, their role and efficacy as support modalities in the present pandemic are unclear. We review the rapidly changing epidemiology, pathophysiology, emerging therapy, and clinical outcomes of COVID-19; and based on these data and previous experience with artificial cardiopulmonary support strategies, particularly in the setting of infectious diseases, provide consensus recommendations from ASAIO. Of note, this is a “living document,” which will be updated periodically, as additional information and understanding emerges.

Risk prediction of in-hospital mortality in patients with venoarterial extracorporeal membrane oxygenation for cardiopulmonary support: The ECMO-ACCEPTS score

PurposeVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly used treatment option for patients in need of mechanical cardiopulmonary support, while available outcome data is limited. The aim of this study was to identify predictors for 30-day in-hospital mortality. Material and methodsWe analyzed baseline characteristics and outcomes of 8351 VA-ECMO procedures performed in Germany from 2007 to 2015. Using a multivariable model, we identified the ten most important variables to allow for prediction of 30-day in-hospital mortality. Based on these variables, we created a mortality prediction score (ECMO-ACCEPTS score) to enhance decision making in patients considered for or treated with VA-ECMO support. ResultsOf 8351 patients (71.7% male) 3567 had prior CPR. Mean age was 62 years in the present cohort. The overall 30-day in-hospital mortality was 61%. The ECMO-ACCEPTS score, derived among randomly selected 4175 patients, included ten independent predictors for in-hospital mortality. Internal validation in the remaining 4176 patients confirmed strong differentiation between low and high risk of 30-day in-hospital mortality (r = 0.97 for correlation of predicted with observed mortality, p < .001). ConclusionsThe ECMO-ACCEPTS score might help clinicians to improve risk prediction among VA-ECMO patients for refractory cardiogenic shock.

RISK PREDICTION IN PATIENTS WITH VENOARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR CARDIOPULMONARY SUPPORT: INSIGHTS FROM A EUROPEAN NATIONWIDE REGISTRY

Venoarterial extracorporeal membrane oxygenation (va-ECMO) is a common treatment option for patients in need of mechanical cardiopulmonary support despite limited outcome data. The aim of this study was to analyze the incidence of va-ECMO therapy as well as describe practice and outcome utilizing

Risk Prediction in Patients with Venoarterial Extracorporeal Membrane Oxygenation for Cardiopulmonary Support: Insights from a European Nationwide Registry

Background: Venoarterial extracorporeal membrane oxygenation (va-ECMO) is a common strategy for prolonged mechanical cardiopulmonary support despite limited outcome data. The aim of this study was to analyze the incidence of va-ECMO therapy as well as describe practice and outcome utilizing complete nationwide data. Moreover, we defined mortality-based predictors for va-ECMO treatment.

Mechanical cardio-pulmonary support in critical care; early experience with Extracorporeal Membrane Oxygenation (ECMO) in Sri Lanka

Mechanical cardio-pulmonary support in critical care; early experience with Extracorporeal Membrane Oxygenation (ECMO) in Sri Lanka

Artificial Organs 2016: A Year in Review.

In this Editor's Review, articles published in 2016 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Mechanical Circulatory Support, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We were pleased to publish our second Virtual Issue in April 2016 on "Tissue Engineering in Bone" by Professor Tsuyoshi Takato. Our first was published in 2011 titled "Intra-Aortic Balloon Pumping" by Dr. Ashraf Khir. Other peer-reviewed Special Issues this year included contributions from the 11th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Ündar and selections from the 23rd Congress of the International Society for Rotary Blood Pumps edited by Dr. Bojan Biocina. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

Anesthetic Management in Radiofrequency Catheter Ablation of Ventricular Tachycardia.

Radiofrequency catheter ablation is increasingly being used to treat patients who have ventricular tachycardia, and anesthesiologists frequently manage their perioperative care. This narrative review is intended to familiarize anesthesiologists with preprocedural, intraprocedural, and postprocedural implications of this ablation. Ventricular tachycardia typically arises from structural heart disease, most often from scar tissue after myocardial infarction. Many patients thus affected will benefit from radiofrequency catheter ablation in the electrophysiology laboratory to ablate the foci of arrhythmogenesis. The pathophysiology of ventricular tachycardia is complex, as are the technical aspects of mapping and ablating these arrhythmias. Patients often have substantial comorbidities and tenuous hemodynamic status, necessitating pharmacologic and mechanical cardiopulmonary support. General anesthesia and monitored anesthesia care, when used for sedation during ablation, can lead to drug interactions and side effects in the presence of ventricular tachycardia, so anesthesiologists should also be aware of potential perioperative complications. We discuss variables that can help anesthesiologists safely guide patients through the challenges of radiofrequency catheter ablation of ventricular tachycardia.

Cardiac support and replacement therapies

Circulatory support represents an integral part within the treatment of the critically ill patient. Sophisticated pharmacologic regimens help to maintain systemic perfusion pressure by increasing vascular tone as well as mediating positive inotropic effects. Besides the administration of catecholamines and phosphodiesterase-III-inhibitors, in particular the administration of levosimendan represents a promising alternative during low-cardiac-output. Nevertheless, sufficient evidence demonstrating a survival benefit for any pharmacologic regimen is nonexistent. In case pharmacological measures do not suffice mechanical cardiopulmonary support (MCS) may be used. MCS may be used during cardiopulmonary resuscitation or a "low-cardiac-output-syndrome" as bridging towards decision, recovery or long-term support. Venoarterial extracorporeal membrane oxygenation (vaECMO) may take over cardiopulmonary function and may improve survival as well as neurological outcome after cardiogenic shock or cardiopulmonary resuscitation.

How can we Challenge the Four-minute Rule?

A manuscript entitled “Maternal Collapse: Challenging the Four-minute Rule” by Benson et al. (2016)), published in EBioMedicine, proposed a new point of view for perimortem Cesarean section (PMCS): one procedure intending not only to save the fetus, but for resuscitation of pregnant women after cardiopulmonary arrest after 20 weeks of gestational age. In obstetrics, obstetric anesthesia, and emergency medicine, the “Four-minute Rule” is regarded as a gold standard for the decision of PMCS; maternal recovery rate after PMCS was significantly decreased when the fetus was delivered over 5 min after maternal cardiac arrest, and a “skilled” obstetrician was expected to complete Cesarean delivery within 1 min of incision. (American Society of Anesthesiologists Task Force on Obstetric Anesthesia, 2007) However, Benson et al. posed the question on this standard that the injury-free survival for mother and baby showed no unique difference between four and five minutes (or any other minutes) of arrest to birth time. And as was expected, their search of the literature proved that many reports of PMCS showed durations longer than 1 min between incision and delivery, regardless of skill. One manuscript describing PMCS from the trainer's point of view was published in 2010 (Dijkman et al., 2010) and showed the increased number of PMCS after training of the procedure. However, in this report, no case of PMCS was completed within 5 min (although 2 out of 3 mothers and all fetuses survived after PMCS 5 to 15 min after arrest), similar to another report to which Benson et al. referred (Einav et al., 2012) (only 4 in 57 cases of PMCS performed and return of spontaneous circulation achieved). The most significant reason for delayed delivery may be hesitation to carry out PMCS; Dijkman claimed that there were no survivors of “out-of-hospital” arrest, even if PMCS was performed (Dijkman et al., 2010). What, then, can we propose next to universalize and improve the results of PMCS? Below are my personal recommendations, beyond the manuscript by Benson et al.: [1] making decisions more quickly, just as quick as possible, [2] changing the 4-minute rule to longer minutes like 10, 15 or 25 min, [3] training all obstetricians or emergency room doctors to complete PMCS within 1 min, or [4] beginning immediate use of mechanical (possibly percutaneous) cardiopulmonary support (or the invention of a new machine usable after shorter preparation). Since [3] and [4] are not realistic, [2] may be the easiest and most reasonable, given that former reports showed expectations of maternal survival at more than 5 min but less than 10 or 15 min (Dijkman et al., 2010, Einav et al., 2012), but as a “rule”, it seems too long. The option [1], proposed in this manuscript by Benson et al., is another possible tactic, but it may cause harsh mental pressure on bystanders to make a decision of non-anesthetic cesarean section within 2 or 3 min after arrest, as it allows only one cycle of cardiac massage and automated external defibrillator (AED) use on basic life support (BLS). However, the latest recommendation by the International Liaison Committee on Resuscitation (ILCOR) also specified that there was no specific time interval by which delivery should begin, which Benson et al. clearly supported in this manuscript (Soar et al., 2015). At least, we must modify the process flow to include PMCS from when we initially encounter cardiac arrest in pregnant women, as a new recommendation.

Artificial Organs 2015: A Year in Review.

In this Editor's Review, articles published in 2015 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for providing their work to this journal. We offer our very special thanks to our reviewers who give so generously of their time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

Right Ventricular Failure Following Acute Type A Aortic Dissection Successfully Treated with ECMO: Report of Two Cases

Patients with acute aortic dissection report often the typical sharp, abrupt chest pain. In some cases, when the disease leads to the coronary malperfusion, the symptoms of acute coronary syndrome may be reported. Low cardiac output as the result of the accompanying coronary flow disturbances can require the mechanical cardiopulmonary support. In some selected cases extracorporeal membrane oxygenation can be successfully used as a bridge to recovery or bridge to decision. The additional advantage of this therapeutic option is the possibility of choice of the cannulation strategy: veno-venous, veno-arterial, veno-pulmonal, central/peripheral. Oxygen delivery can be easily regulated on oxygenator. We present two patients with acute type A aortic dissection and acute coronary syndrome, who recovered thanks to such therapy.

0230 : Effectiveness of extracorporeal life support for patients with cardiogenic shock due to intractable arrhythmic storm

Extracorporeal life support (ECLS) provides mechanical cardiopulmonary support and has been used for intractable heart failure as a bridge to heart transplantation or to recovery. Intractable arrhythmic storm is associated with high mortality. Little is known about the effectiveness of ECLS to treat refractory ventricular arrhythmias responsible for cardiogenic shock in patients non eligible for an urgent ablation. Patients with intractable refractory ventricular arrhythmias and cardiogenic shock despite optimal medical therapy, and treated by ECLS implantation were retrospectively included. Patients’ characteristics and outcome were analyzed. 20 patients (53±10 yo) were included. The underlying etiology to the refractory ventricular storm was ischemic cardiomyopathy (75%), short coupled Torsades de Pointes (10%), dilated cardiomyopathy (5%), myocarditis (5%) or unknown (5%). Mean LVEF was 33±17%. An average of 2.3±1.2 anti-arrhythmic drugs was tried before implantation. Arrhythmic storm stopped after a median time of 15min after ECLS implantation. 8 patients (40%) eventually died, none of them because of a complication of ECLS implantation. The remaining 12 patients (60%) had ECLS withdrawn after a median time of 5.3 days, and were discharged after a median time of 29 days after admission (survival curve in the figure). This is the largest database of patients temporary implanted with ECLS for refractory ventricular arrhythmia responsible for cardiogenic shock and non eligible for ablation. It provides efficient hemodynamic support to these critically ill patients, and survival rate after the implantation is 60%.Download : Download full-size imageFigure: Survival curve Figure: Survival curve

Artificial organs 2014: a year in review.

In this Editor's Review, articles published in 2014 are organized by category and briefly summarized. We aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. As the official journal of the International Federation for Artificial Organs, the International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, the International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers, the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons, for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.