[Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery].
OBJECTIVE
To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery.


METHODS
Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases.


RESULTS
Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4).


CONCLUSIONS
ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.
Jia
Ming
M
Department of Post-operation, Intensive Care Unit of the Cardiac Surgery, Capital University of Medical Science Affiliated Beijing Anzhen Hospital, Beijing 100029, China.
Hu
Wen-li
WL
Zhou
Ye
Y
Shao
Juan-juan
JJ
Yan
Xiao-lei
XL
Song
Tie-ying
TY
Hou
Xiao-tong
XT
Jia
Shi-jie
SJ
Meng
Xu
X
D000208:Acute Disease; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies