First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation.
OBJECTIVE
The aim of this manuscript is to describe the first year of our experience using extracorporeal membrane oxygenation support.


METHODS
Ten patients with severe refractory hypoxemia, two with associated severe cardiovascular failure, were supported using venous-venous extracorporeal membrane oxygenation (eight patients) or veno-arterial extracorporeal membrane oxygenation (two patients).


RESULTS
The median age of the patients was 31 yr (range 14-71 yr). Their median simplified acute physiological score three (SAPS3) was 94 (range 84-118), and they had a median expected mortality of 95% (range 87-99%). Community-acquired pneumonia was the most common diagnosis (50%), followed by P. jiroveci pneumonia in two patients with AIDS (20%). Six patients were transferred from other ICUs during extracorporeal membrane oxygenation support, three of whom were transferred between ICUs within the hospital (30%), two by ambulance (20%) and one by helicopter (10%). Only one patient (10%) was anticoagulated with heparin throughout extracorporeal membrane oxygenation support. Eighty percent of patients required continuous venous-venous hemofiltration. Three patients (30%) developed persistent hypoxemia, which was corrected using higher positive end-expiratory pressure, higher inspired oxygen fractions, recruitment maneuvers, and nitric oxide. The median time on extracorporeal membrane oxygenation support was five (range 3-32) days. The median length of the hospital stay was 31 (range 3-97) days. Four patients (40%) survived to 60 days, and they were free from renal replacement therapy and oxygen support.


CONCLUSIONS
The use of extracorporeal membrane oxygenation support in severely ill patients is possible in the presence of a structured team. Efforts must be made to recognize the necessity of extracorporeal respiratory support at an early stage and to prompt activation of the extracorporeal membrane oxygenation team.
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil. mpark@uol.com.br
Marcelo
M
Park
Luciano Cesar Pontes
LC
Azevedo
Pedro Vitale
PV
Mendes
Carlos Roberto Ribeiro
CR
Carvalho
Marcelo Brito Passos
MB
Amato
Guilherme Paula Pinto
GP
Schettino
Mauro
M
Tucci
Alexandre Toledo
AT
Maciel
Leandro Utino
LU
Taniguchi
Edzangela Vasconcelos Santos
EV
Barbosa
Raquel Oliveira
RO
Nardi
Michelle de Nardi
Mde N
Ignácio
Cláudio Cerqueira
CC
Machtans
Wellington Alves
WA
Neves
Adriana Sayuri
AS
Hirota
Eduardo Leite Vieira
EL
Costa
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012119:Respiration; D012131:Respiratory Insufficiency / Q000628:therapy*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult