Interv Akut Kardiol. 2010;9(3):121-128

Profile of patients treated with extracorporeal membrane oxygenation (ECMO)

Jan Bělohlávek¹, Vilém Rohn², Jan Kunstýř³, Jan Tošovský², Martin Balík³, Michal Semrád², Jan Horák¹, Michal Lipš³, Severyn Romaniv³, František Mlejnský², Igor Vykydal², Jan Krištof³, Martin Stříteský³, Vratislav Mrázek¹, Aleš Linhart¹, Jaroslav Lindner²

Kardiocentrum VFN a 1. LF UK, Praha

¹ II. interní klinika kardiologie a angiologie VFN a 1. LF UK, Praha

² II. chirurgická klinika kardiovaskulární chirurgie VFN a 1. LF UK, Praha

³ Klinika anesteziologie, resuscitace a intenzivní medicíny VFN a 1. LF UK, Praha

Introduction: Extracorporeal membrane oxygenation (ECMO) is a recognized rescue method in severe respiratory and/or cardiac failure

in children and neonates and, in recent years, it has been increasingly used in adults as well. Support with the ECMO system can be

started very rapidly in urgent situations using both percutaneous and surgical approach and provides a bridge to decision, switch to

other supportive measures or urgent organ transplantation.

Objective: To introduce the expert public to the experience with the ECMO programme at the Heart Centre.

Methods, patients and results: The so-called ECMO team consisting of representatives of individual fields involved in the ECMO

programme is responsible for the indication and course of ECMO support in all patients. Since establishing the ECMO team at our institution

in October 2007, a total of 30 consecutive patients were indicated for mechanical cardiac support by the end of February 2010.

ECMO support was eventually started in 27 patients, one female patient died during implantation, one was connected to right ventricle

assist device and one to left ventricle assist device. In ECMO patients, venoarterial approach was used in 18 cases, venovenous in nine,

central surgical approach was chosen in three and, in the remaining patients, peripheral approach was used. Two patients were treated

as planned prior to high-risk percutaneous coronary intervention, in all the others it was an urgent setting. The most frequent indication

for ECMO support was postcardiotomy cardiogenic shock (14 cases) and unmanageable respiratory failure characteristic of ARDS (9 cases,

5 of which were related to H1N1 infection). Four patients had severe right-sided cardiac failure and three patients had acute myocardial

infarction with ventricular septal rupture. The mean time on support was 8 days (1–28 days). Fourteen patients (52 %) were successfully

weaned from ECMO, of whom two died after a subsequent long-term hospitalization, ten (37 %) survived to discharge and two patients

were still hospitalized when this paper was being prepared.

Conclusion: ECMO allows stabilization and treatment of patients with severe cardiorespiratory failure and, in the Heart Centre, ECMO

support is most commonly indicated for postcardiotomy cardiogenic shock, severe ARDS and cardiogenic shock in postinfarction ventricular

septal rupture. With respect to the critical condition of the patients, the mortality of 60 percent is regarded as an acceptable

outcome. The authors consider the ECMO programme a justifiable part of a set of therapeutical methods in a modern heart centre. An

essential prerequisite of successful patient care is a constructive multidisciplinary approach and cooperation.

Keywords: extracorporeal membrane oxygenation, cardiogenic shock, respiratory failure, cardiac failure, team

Published: June 1, 2010  Show citation