Extracorporeal membrane oxygenation for adult post cardiotomy cardiogenic shock using a heparin bonded system.
Extracorporeal membrane oxygenation (ECMO) for adult post cardiotomy cardiogenic shock has had limited success. The efficacy of a heparin bonded ECMO system was tested in 11 patients (eight men, three women; mean age: 63 +/- 8 years), all of whom were in post cardiotomy shock refractory to inotropes and intra-aortic balloon pumping (IABP). The system consisted of a right atrial-to-aortic loop using a hollow fiber oxygenator driven by a vortex pump. All blood contact surfaces were heparin bonded. Mean duration of support was 47.9 hr (range: 22-92.5 hr). Mean prothrombin time, activated partial thromboplastin time, and activated clotting time during full support were 17 +/- 8, 57.5 +/- 38, and 152 +/- 59 sec, respectively. Mean transfusion requirements for packed red blood cells, fresh frozen plasma, and platelets were 24 +/- 9, 19 +/- 9, and 38 +/- 15 units, respectively. Complications included acute renal failure (1 patient), sepsis (3 patients), elevation of hepatic enzymes (7 patients), and myocardial infarction (11 patients). Oxygenator failure occurred in 4 patients, and 10 patients had plasma hemoglobin levels exceeding 30 mg/L. No patient experienced focal neurologic deficit. Eight (73%) patients were weaned from ECMO. Five (45.4%) of these are alive and have been discharged home with a mean follow-up of 317 +/- 76 days (range: 179-416 days). This heparin-free ECMO system allows rapid and simple deployment and provides effective short-term cardiopulmonary support.
Lazzara
R R
RR
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212.
Magovern
J A
JA
Benckart
D H
DH
Maher
T D
TD
Sakert
T
T
Magovern
G J
GJ
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D002315:Cardiopulmonary Bypass; D003327:Coronary Disease / Q000097:blood / Q000601:surgery*; D003404:Creatinine / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006349:Heart Valve Diseases / Q000097:blood / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000187:drug effects; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000097:blood / Q000628:therapy*; D013499:Surface Properties; D016896:Treatment Outcome
D005340:Fibrinogen; D006493:Heparin; D003404:Creatinine