Adult extracorporeal life support: a failed or forgotten concept?
BACKGROUND
The extracorporeal membrane oxygenation (ECMO) has been used in the neonatal and childhood periods with excellent results. The adult experience has been modest with inferior immediate results. The intermediate survival, however, has been promising. We have been using the extracorporeal membrane oxygenation for temporary mechanical circulatory support of adults that present with acute refractory cardiogenic shock in our institution. There is no other published experience of the use of this system in this scenario in Brazil.


OBJECTIVE
To describe our experience with the use of the extracorporeal membrane oxygenation for circulatory support in adults.


METHODS
Retrospective analysis of the medical files of patients submitted to the implant of extracorporeal membrane oxygenation system for circulatory assistance in acute and refractory cardiogenic shock.


RESULTS
Eleven patients (63,5 yo; 45,5% male) were considered for analysis from 2005 to 2007. Median support time was 77 hours (10-240 h) and 5 patients have survived 30 days (45,5%). Two patients were subsequently submitted to prolonged paracorporeal circulatory assistance. Mortality on ECMO (6 patients) was due to multiple organ failure (66,6%) and refractory bleeding (33,4%).


CONCLUSIONS
ECMO system is an option to be used in acute refractory cardiogenic shock as a bridge to recovery or selecting patients that might benefit from prolonged paracorporeal assist devices (bridge to bridge).
Colafranceschi
Alexandre Siciliano
AS
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil. acolafranceschi@hotmail.com
Monteiro
Andrey José de Oliveira
AJ
Canale
Leonardo Secchin
LS
Campos
Luiz Antonio de Almeida
LA
Montera
Marcelo Westerlund
MW
Silva
Paulo Roberto Dutra da
PR
Fernandes
Marcelo Ramalho
MR
Pinto
Alexandre de Araújo
Ade A
Molas
Stelmar Moura
SM
Mesquita
Evandro Tinoco
ET
D000328:Adult; D001938:Brazil / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality / Q000592:standards*; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate