Mechanical support requirement in young patient with severe heart failure

Introduction: T he use of mechanical circulatory support through extracorporeal venous-arterial circulation (ECMA-VA) has been relatively recently im-plemented in extreme situations such as circulatory shutdown, but with results still unclear and using criteria of heterogeneous indication within the various centers. Young patients, with circulatory stop with witnesses, resuscitated up to 30 minutes by properly trai-ned medical personnel is probably the best indication.

Case presentation: 32-year-old patient without APP is transferred for severe phenomena of acute heart failure. The patient is brought to the guard room in serious, agitated condition, with signs of tissue hypoperfusion. 5 minutes after arrival develop cardiac arrest by mechanical activity without pulse. Resuscitation manoeuvres are initiated; with succes, after 20 minutes heart rate is obtain, positive inotropic support is initiated. Emer-gency echocardiography shows severe biventricular systolic dysfunction. The patient is transferred to the catheterization room for the establishment of mechanical circulatory support with intra-aortic balloon counterpulsation (IABC). Under maximum pharmacologi-cal support and minimal mechanical, after 30 minutes the patient remains hemodynamically unstable. It is decided to climb the mechanical circulatory support by mounting ECMO-VA by percutaneous approach in the catheterization room. Rapidly favorable evolution, with 72-hour improvement of systolic dysfunction of the right ventricle, which allowed the sevration of ECMO after 7 days, and on the tenth day of evolution the sevration and IABC. It is transferred to the ICU, being rapidly sevred by positive inotropic and with the initiation and rapid uptittration of neurohormonal medication. The patient was discharged after another 10 days, without signs or symptoms of heart failure, with good tolerance to exertion.

Particularity: The use of ECMO-VA for extreme hemodynamic situations may be an appropriate indica-tion when patients are correctly selected. Sevration as quickly as possible to avoid thrombotic and/or hemorrhagic complications is essential. Also, the faster intro-duction of neurohormonal medication during hospita-lization is essential for improving functional capacity and improving long-term prognosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)