[Extracorporeal membrane oxygenation for treatment of cardiorespiratory function failure in adult patients]

Abstract

Objective: To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure.

Methods: From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0 +/- 14.1) years. Average body weight was (67.0 +/- 12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n = 31), post-transplantation (group 2, n = 5), decompensate of chronic heart failure (group 3, n = 9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta.

Results: Average support duration of ECMO was (126.7 +/- 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42.2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58.1% in group 1, 4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasis. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19).

Conclusion: Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.