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ECPR in acute aortic dissection – Really a no-go?

Published:April 22, 2019DOI:https://doi.org/10.1016/j.ajem.2019.04.038
      The use of extracorporeal membrane oxygenation (ECMO) [
      • Thiagarajan R.R.
      • Barbaro R.P.
      • Rycus P.T.
      • McMullan D.M.
      • Conrad S.A.
      • Fortenberry J.D.
      • et al.
      Extracorporeal life support organization registry international report 2016.
      ] and its implementation into institutional protocols for extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly increasing [
      • Thiagarajan R.R.
      • Barbaro R.P.
      • Rycus P.T.
      • McMullan D.M.
      • Conrad S.A.
      • Fortenberry J.D.
      • et al.
      Extracorporeal life support organization registry international report 2016.
      ,
      • Haas N.L.
      • Coute R.A.
      • Hsu C.H.
      • Cranford J.A.
      • Neumar R.W.
      Descriptive analysis of extracorporeal cardiopulmonary resuscitation following out-of-hospital cardiac arrest-an ELSO registry study.
      ,
      • Napp L.C.
      • Kühn C.
      • Bauersachs J.
      ECMO in cardiac arrest and cardiogenic shock.
      ]. One of the commonly reported contraindications to veno-arterial ECMO is acute aortic dissection, although no studies on feasibility, safety and efficacy of ECPR in this condition exist. In this context we read with great interest the report of Kelly et al. in the Journal [
      • Kelly C.
      • Ockerse P.
      • Glotzbach J.P.
      • Jedick R.
      • Carlberg M.
      • Skaggs J.
      • et al.
      Transesophageal echocardiography identification of aortic dissection during cardiac arrest and cessation of ECMO initiation.
      ]. While we fully agree that transesophageal echocardiography (TEE) is still underutilized especially in emergency medicine and intensive care, the decision against veno-arterial ECMO upon identification of acute aortic dissection Type A (AADA) raised some concerns to us.

      Keywords

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