Ismael A. Salas de Armas

The University of Texas Health Science Center at Houston

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Igor D. Gregorič

The University of Texas Health Science Center at Houston

Biswajit Kar

The University of Texas Health Science Center at Houston

Mehmet H. Akay

The University of Texas Health Science Center at Houston

Manish Kumar Patel

Centre for Plant Biotechnology and Genomics

Bindu Akkanti

The University of Texas Health Science Center at Houston

Jayeshkumar Patel

The University of Texas Health Science Center at Houston

Sriram Nathan

The University of Texas Health Science Center at Houston

Kha Dinh

The University of Texas Health Science Center at Houston

Angelo Nascimbene

The University of Texas Health Science Center at Houston

Juan Marcano

The University of Texas Health Science Center at Houston

Cooperative Institutions

The University of Texas Health Science Center at Houston

112

Memorial Hermann

Texas Medical Center

Memorial Hermann–Texas Medical Center

The University of Texas MD Anderson Cancer Center

University of Houston

Baylor College of Medicine

Methodist Hospital

University of Kentucky

Office of Multidisciplinary Activities

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Tracheostomy while on Extracorporeal Membrane Oxygenation: A Comparison of Percutaneous and Open Procedures.

Journal of ExtraCorporeal Technology (2020)

Ismael A. Salas de Armas Kha Dinh Bindu Akkanti Pushan Jani Reshma Hussain

Although the ideal timing of tracheostomy for critically ill patients is controversial, transitioning from an endotracheal tube can be beneficial. Concerns arise for patients under extracorporeal membrane oxygenation (ECMO) support. Studies have described percutaneous and open tracheostomy approaches for critically ill patients but, to our knowledge, have not compared the two specifically in ECMO patients. This study analyzed safety and aimed to identify if there was a difference in major bleeding or other tracheostomy-associated complications. A single-center retrospective cohort study of all patients who received tracheostomy while on ECMO from July 2013 to May 2019 was completed. The primary endpoint was a significant difference in the incidence of a major bleeding adverse event at 48 hours. Secondary endpoints included differences in the incidence of complications (e.g., procedure-related mortality, ECMO decannulation, tracheal/esophageal injury, and pneumothorax/pneumomediastinum) and survival to discharge. A secondary analysis separated the groups further by comparing those with bleeding events and those without. The study included 27 ECMO patients: 16 (59%) in the percutaneous arm and 11 in the open arm. The median number of ECMO days before tracheostomy was 10 vs. 13, respectively. There were no statistically significant differences between the two groups for major bleeding events (percutaneous 44% vs. open 27%, p = .45), procedure-related mortality, or procedure-related complications. Both percutaneous and open tracheostomies in patients on ECMO require a multidisciplinary approach to minimize adverse effects. Major bleeding does occur, but there was no statistically significant correlation between bleeding events and the type of the tracheostomy approach. Thus, both open and percutaneous tracheostomy approaches have a favorable safety profile.

Pneumomediastinum

Clinical endpoint

10.1182/ject-2000027

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Citations (3)

Left Ventricular Rupture After Impella® Placement During High-Risk Percutaneous Coronary Intervention

Cardiovascular revascularization medicine (2019)

Ismael A. Salas de Armas Sachin Kumar Ahmed Almustafa Bindu Akkanti Mehmet H. Akay

Impella

Perforation

10.1016/j.carrev.2019.06.011

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Citations (4)

The use of veno-arterial extracorporeal membrane oxygenation in the octogenarian population: A single-center experience

Perfusion (2022)

Ismael A. Salas de Armas Linda Holifield Lisa Janowiak Mehmet H. Akay Maria Patarroyo

Advanced age is a known risk factor for poor outcomes after veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiac support. The use of ECMO support in patients over the age of 80 is controversial, and sometimes its use is contraindicated. We aimed to assess the use of ECMO in octogenarian patients to determine survival and complication rates.A single-center, retrospective analysis was completed at a large, urban academic medical center. Patients requiring V-A ECMO support between December of 2012 and November of 2019 were included as long as the patient was at least 80 years of age at the time of cannulation. Post cardiotomy shock patients were excluded.A total of 46 patients met eligibility criteria; all received V-A ECMO support. Overall, the majority of patients (71.7%; 33/46) survived to decannulation, and 43.5% (20/46) survived to discharge. Patients who were previously rescued from percutaneous interventions tend to have a better survival than other patients (p = .06). The most common complications were renal and hemorrhagic.We demonstrated that advanced age alone should not disqualify patients from cannulating and supporting with V-A ECMO.

Cardiotomy

Single Center

Contraindication

10.1177/02676591221111506

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Citations (4)

Management of P Management of Patients with Refr atients with Refractory Cardiogenic Shock and diogenic Shock and Cardiointestinal Syndrome with Impella 5.5 as Bridge to Decision: Case Series

Deleted Journal (2022)

Ismael A. Salas de Armas Bindu Akkanti Anju Bhardwaj

Patients with advanced heart failure require multi-system management as a majority succumb to end-organ dysfunction, including gastrointestinal sequelae. Temporizing measures, such as early mechanical circulatory support, can assist in the recovery of patients with acute cardiogenic shock. The temporary support can improve patient characteristics to enable future definitive heart failure therapies such as durable left ventricular assist devices and orthotopic heart transplantation. We present two cases of cardiogenic shock that were successfully bridged with an Impella 5.5 (Abiomed). The management enabled the patients to recover from reversible cardiointestinal syndrome and undergo successful definitive therapies.

Impella

Refractory (planetary science)

10.57905/josh/e20231216

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Use of Percutaneous Left Ventricular Assist Device Before Durable Device Implantation in Patients With Cardiac Cachexia: Case Series

ASAIO Journal (2023)

Ismael A. Salas de Armas Amanda Bergeron Bindu Akkanti Mehmet H. Akay Alison Scovell

Frailty and malnutrition in patients with heart failure are barriers to durable left ventricular assist device (D-LVAD) support and heart transplantation. Moreover, cachexia in patients with advanced heart failure carries a high mortality risk. There are no guidelines for these patients other than increased caloric intake and rehabilitation. Patients suffering from cardiac cachexia and heart failure may benefit from temporary, percutaneous assist device support to improve the underlying heart disease and reverse the catabolic state. We retrospectively reviewed patients from January 2017 to January 2022. All patients who received Impella support (5.0 or 5.5, Abiomed) before D-LVAD implantation were screened. Those who met the criteria for cardiac cachexia were included. Patient demographics, nutritional and biochemical markers, and survival data were collected. A total of 14 patients were included. The majority of patients were male (85.7%) with ischemic cardiomyopathy (64.3%). Caloric intake, physical strength, and ambulation improved. Prealbumin levels improved from a median of 13.7–18.0 mg/dl ( p < 0.006) while on Impella 5.0 or 5.5 support. All patients survived to discharge and the 6 month follow-up. In conclusion, use of the Impella device improves cardiogenic shock symptoms and, consequently, may improve cachexia status prior to D-LVAD implantation.

Impella

10.1097/mat.0000000000001902

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Citations (7)

Laparoscopic single port surgery in children using Triport: our early experience

Pediatric Surgery International (2011)

Ismael A. Salas de Armas Isabella Garcia Ashwin Pimpalwar

Gold standard (test)

Demographics

Port (circuit theory)

10.1007/s00383-011-2892-6

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Citations (30)

Accidental Lumbar Vein Cannulation During Emergent Veno-Venous Extracorporeal Membrane Oxygenation Initiation: Case Report

ASAIO Journal (2024)

Oriana Salamó Kha Dinh Juan Marcano Richard Witkov M. Patel

Accidental

10.1097/mat.0000000000002309

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Aortic Root Dissection Due to an Automated Fastener Device

Texas Heart Institute Journal (2022)

Ismael A. Salas de Armas L. Maximilian Buja Manish Kumar Patel Jayeshkumar Patel Mehmet H. Akay

Minimally invasive aortic valve replacement through a right thoracotomy is frequently performed in patients with aortic valve disease. The Cor-Knot Device (LSI Solutions) is an automated fastener that secures valve sutures. This case report is for a patient who developed postcardiotomy shock during a minimally invasive aortic valve surgery. The patient was found to have an aortic root dissection involving 90% of the aortic root circumference, including bilateral coronary ostia. The autopsy revealed that the aortic damage could be explained by a direct aortic intimal tear from the distal tip of the device shaft. The device was most likely not in perfect apposition to the sewing ring because of the restricted angle and space between the ribs.

Thoracotomy

10.14503/thij-20-7531

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Citations (1)

Transcatheter and Surgical Aortic Valve Replacement Outcomes for Patients with Chronic Heart Failure

Journal of Cardiothoracic and Vascular Anesthesia (2020)

Talha Mubashir Julius Balogh Rabail Chaudhry Cooper Quiroz Biswajit Kar

Valve replacement

10.1053/j.jvca.2020.06.082

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Citations (3)

Inter-hospital COVID ECMO air transportation

Perfusion (2020)

Ismael A. Salas de Armas Bindu Akkanti Lisa Janowiak Igor Banjac Kha Dinh

The Coronavirus Disease 2019 (COVID-19) pandemic has required rapid and effective protocol adjustments at every level of healthcare. The use of extracorporeal membrane oxygenation (ECMO) is pivotal to COVID-19 treatment in cases of refractory hypoxemic hypercapnic respiratory failure. As such, our large, metropolitan air ambulance system in conjunction with our experts in advanced cardiopulmonary therapies modified protocols to assist peripheral hospitals in evaluation, cannulation and initiation of ECMO for rescue and air transportation of patients with COVID-19 to our quaternary center. The detailed protocol is described alongside initial data of its use. To date, 14 patients have been placed on ECMO support at an outside facility and successfully transported via helicopter to our hub hospital using this protocol.

Pandemic

2019-20 coronavirus outbreak

10.1177/0267659120973843

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Citations (18)