ABSTRACT
BACKGROUND: Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure. METHODS: PubMed, Embase, and Google Scholar were queried on September 27, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to intensive care unit (ICU) discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded. RESULTS: Out of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports, and 12 were case series, representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were moved to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was 12 days (interquartile range 8-23 days), and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported. CONCLUSION: OxyRVAD support is a promising alternative for RV support when gas exchange is compromised, with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
ABSTRACT
A 56-year-old woman working in a factory for the past 34 years presented with dilated cardiomyopathy of unknown etiology. She was exposed daily to toluene at work, without adequate protective equipment. A public health department investigation reported that toluene exposure among workers at her factory was more than 3 times the established limit. Toluene inhalation is associated with cases of cardiac arrhythmias, vasospasm, and cardiomyopathy. Occupational exposure to cardiotoxic substances should be investigated in patients with idiopathic cardiomyopathy. This case report highlights an association between a case of dilated cardiomyopathy and chronic exposure to toluene.
Une femme de 56 ans, employée dans une usine pendant 34 ans, a reçu un diagnostic de cardiomyopathie dilatée de cause inconnue. Au travail, elle était exposée quotidiennement au toluène, sans équipement de protection adéquat. Une enquête effectuée par le département de santé au travail de la santé publique a révélé que les travailleurs de cette usine étaient exposés à une concentration de toluène supérieure à 3 fois la limite établie. L'inhalation de toluène a déjà été associée à des cas d'arythmies cardiaques, de vasospasmes et de cardiomyopathies. La possibilité d'une exposition professionnelle à des substances cardiotoxiques devrait être examinée chez les patients atteints de cardiomyopathie idiopathique. Cet article met ainsi en évidence un cas de cardiomyopathie dilatée associé à une exposition chronique au toluène.
