Early Experience And Mid-term Outcomes Of Veno-arterial Extra-corporeal Membrane Oxygenator
Ibrahim M. Yassin1, Khaled Al Khamees2, Sherif K. Al Nosairy3, Hatem Al Taher3, Mustafa Al Refaei4, Khaled Eskander2.
1Cardio-Thoracic Surgery Department, Tanta University, Tanta, Egypt, 2Cardiac Surgery Department,Saud al-Babtin Cardiac Center SBCC, AL DAMMAM, Saudi Arabia, 3Anaesthesia Department,Saud al-Babtin Cardiac Center SBCC, AL DAMMAM, Saudi Arabia, 4Cardiology Department,Saud al-Babtin Cardiac Center SBCC, AL DAMMAM, Saudi Arabia.
OBJECTIVE: VA- ECMO was implanted in 14 refractory cardiogenic shock ( rCS ) in our recently developed program. We sought to evaluate this early experience, successful weaning, 30days survival and also the midterm results.
METHODS: Our retrospective 14 patients study was from Jan. 2014 to March 2016 (51.0 ± 6.6 years) (M=85.7%).Two groups could be identified according to the cause of rCS. Post-cardiotomy (P-C) Group: (5/14)(36%) (M=60%) (50.4 ± 5.46 years) and Non post cardiotomy (Non P-C) mainly Post Anterior Myocardial Infarction(P-AMI) Group: (9/14)(64%)(M=100%) (51.3 ± 7.45 years).The standard Cut down femoral exposure was employed in all the(P-C) group except one case(central insertion) due to severe peripheral vascular disease. In (Non P-C) Group, the Seldinger’s technique with antegrade perfusion of the ipsilateral lower limb percutaneously except two cases through the usual Cut Down surgical method was performed , one due to obesity and the other due to bad back flow ).The Non P-C Group included (7/9)(77.8%)(P-AMI) and one case(1/9)(11.1%) (fulminant myocarditis). Veno-Veno-Arterial(V-V- A ECMO) was employed in the second case (1/9)(11.1%) due to adjuvant acute respiratory failure
RESULTS: Seven patients (7/14)(50%) suffered early complications( three wound infections, one local dissection, one big haematoma, one compartmental syndrome, and one acute limb ischaemia)and all managed successfully with mean duration of support (8.43 ± 5.64) days. In P-C group ( 10.2 ± 7.33) and in Non P-C group (7.44 ± 4.67) (P=0.4). Ten patients(10/14) (71.4%) were weaned successfully from ECMO in the total population. (2/5)(40%) in P-C group and (8/9)(88.9%)in Non P-C group. The 30-day survival was (8/14)(57.1%) in the total population. (1/5)(20%) in P-C group(one patient expired due to Intracranial Hemorrhage)and(7/9)(77.8%)in the Non P-C group(one patient expired due to acute instent thrombosis). The mid-term survival of the total 30-day survived patients was (6/8)(75%) and(6/14)(42.9%) of the total population of the study. The one patient(20%) in P-C group was 100% and of the seven patients (77.8%) in the Non P-C group was 71.4%(5/7).
CONCLUSIONS: Building up an ECMO program can be achieved in a reasonable time with accepted early outcome. ECMO is a practical bridge in patients with to recovery or further intervention.
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