Format

Send to

Choose Destination
Ann Transl Med. 2017 Feb;5(4):73. doi: 10.21037/atm.2017.01.39.

Extracorporeal life support for refractory ventricular tachycardia.

Author information

1
Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
2
Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA;; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
3
Department of Anesthesiology, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
4
Department of Anesthesiology, The University of Athens, Athens, Greece.

Abstract

Extracorporeal life support (ECLS) is a very effective bridging therapy in patients with refractory ventricular tachycardia (VT) associated with cardiogenic shock. A moribund patient in extremis, is not amenable to optimization by standard ACC/AHA guidelines. New approaches and novel salvage techniques are necessary to improve outcomes in patients with refractory clinical settings such as malignant ventricular arrhythmias, cardiac arrest, cardiogenic shock and/or pulmonary failure until further management options are explored. Data base searches were done using key words such as ECLS, VT, cardiac arrest, VT ablation, venoarterial extra-corporeal membrane oxygenation (VA-ECMO). The use of ECLS has been described in a few case reports to facilitate VT ablation for incessant VT refractory to medical therapy. For patients with, out-of- hospital ventricular fibrillation (VF) and VT, Minnesota Resuscitation Consortium has implemented emergent advanced perfusion and reperfusion strategy, followed by coronary angiography and primary coronary intervention to improve outcome. The major indications for ECLS are cardiogenic shock related to acute myocardial infarction, myocarditis, post embolic acute cor pulmonale, drug intoxication and post cardiac arrest syndrome with the threat of multi-organ failure. ECLS permits the use of negative inotropic antiarrhythmic drug therapy, facilitates the weaning of catecholamine administration, thereby ending the vicious cycle of catecholamine driven electric storm. ECLS provides hemodynamic support during ablation procedure, while mapping and induction of VT is undertaken. ECLS provides early access to cardiac catheterization laboratory in patients with cardiac arrest due to shockable rhythm. The current evidence from literature, supports the use of ECLS to ensure adequate vital organ perfusion in patients with refractory VT. ECLS is a safe, feasible and effective therapeutic option when conventional therapies are insufficient to support cardiopulmonary function. A highly driven multidisciplinary team approach is essential to accomplish this task.

KEYWORDS:

Ventricular tachycardia (VT); extracorporeal life support (ECLS); venoarterial extra-corporeal membrane oxygenation (VA-ECMO)

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Publication type

Publication type

Supplemental Content

Full text links

Icon for AME Publishing Company Icon for PubMed Central
Loading ...
Support Center