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. 2012 Oct;67(10):1157-63.
doi: 10.6061/clinics/2012(10)07.

First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

Marcelo Park  1 , Luciano Cesar Pontes Azevedo, Pedro Vitale Mendes, Carlos Roberto Ribeiro Carvalho, Marcelo Brito Passos Amato, Guilherme Paula Pinto Schettino, Mauro Tucci, Alexandre Toledo Maciel, Leandro Utino Taniguchi, Edzangela Vasconcelos Santos Barbosa, Raquel Oliveira Nardi, Michelle de Nardi Ignácio, Cláudio Cerqueira Machtans, Wellington Alves Neves, Adriana Sayuri Hirota, Eduardo Leite Vieira Costa
Affiliations

First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation

Marcelo Park et al. Clinics (Sao Paulo). 2012 Oct.

Abstract

Objectives: The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support.

Methods: Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients).

Results: The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support.

Conclusions: The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.

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Conflict of interest statement

No potential conflict of interest was reported.

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