Refractory cardiogenic shock due to extensive anterior STEMI with covered left ventricular free wall rupture treated with awake VA-ECMO and LVAD as a double bridge to heart transplantation - collaboration of three cardiac centres.
OBJECTIVE
To highlight an optimal collaborative strategy of three different levels of specialized care cardiac centres.


BACKGROUND
Refractory cardiogenic shock is a life-threatening condition. A myocardial recovery is not achieved in many cases despite all efforts and subsequently the heart transplantation remains an ultimate option. Thereby, the use of extracorporeal membrane oxygenation (ECMO) followed by a ventricular assist device in staged bridging provides an attractive approach.


METHODS
We report on an optimal cooperation of PCI (percutaneous coronary intervention) centre with ELSO (extracorporeal life support organization) centre and transplant centre in a patient suffering from refractory cardiogenic shock due to acute myocardial infarction (RCSMI) complicated by left ventricle free wall rupture with pericardial tamponade.


CONCLUSIONS
The interhospital collaboration can be essential in the context of patients with RCSMI. The use of ECMO enables safe interhospital transport and gains time for further diagnostic and therapeutic steps in such critically ill patients.
Department of Cardiology, Bulovka Hospital, Prague, Czech Republic.
Jan
J
Kacer
Department of Cardiology, Bulovka Hospital, Prague, Czech Republic.
Michaela
M
Lindovska
Department of Cardiology, Bulovka Hospital, Prague, Czech Republic.
Roman
R
Surovcik
Cardiovascular Surgery Department, IKEM, Prague.|2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague.
Ivan
I
Netuka
2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague.
Frantisek
F
Mlejnsky
2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague.
Tomas
T
Grus
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague.
Jan
J
Belohlavek
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001243:Assisted Circulation; D003325:Coronary Care Units; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D006342:Heart Rupture, Post-Infarction / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008875:Middle Aged; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000628:therapy*
extracorporeal membrane oxygenation; left ventricle assist device; percutaneous coronary intervention; refractory cardiogenic shock in acute myocardial infarction