Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. A retrospective medical record review (April 2009 to 2015) was performed...

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Veröffentlicht in:Journal of critical care 2018-04, Vol.44, p.31-38
Hauptverfasser: Sun, Terri, Guy, Andrew, Sidhu, Amandeep, Finlayson, Gordon, Grunau, Brian, Ding, Lillian, Harle, Saida, Dewar, Leith, Cook, Richard, Kanji, Hussein D.
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Sprache:eng
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Zusammenfassung:Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO. A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1–2). There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition. The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes. •Mean duration from start of CPR to initiation of VA-ECMO was 103.73min (±98.41).•Successful weaning from VA-ECMO in 78% of patients•Survival rate with good neurological condition (CPC 1-2) was 67%) for E-CPR, 69% for E-CS and 68% overall
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2017.10.011