title: Venovenous extracorporeal membrane oxygenation is effective against post-cardiotomy acute respiratory failure in adults.
abstract: BACKGROUND
  Acute respiratory failure is a serious issue that occasionally occurs after weaning from cardiopulmonary bypass (CPB) after heart surgery. This condition can be refractory to mechanical ventilation and the mortality rate is high. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is applied to treat acute lung failure after CPB at our institution. This report describes the use of VV-ECMO after cardiac surgery at a single institution.
  
  
  METHODS
  We analyzed the outcomes of 11 patients who developed severe acute respiratory failure requiring VV-ECMO after undergoing heart surgery with a cardiopulmonary bypass.
  
  
  RESULTS
  Four (36.4%) patients died in hospital. One patient required conversion from VV- to venoarterial (VA-) ECMO because of circulatory instability. One patient each died of respiratory failure and heart failure and two died of ischemic colitis. Lung damage secondarily developed in these four patients to other disabled organs. Seven (63.6%) patients whose lungs were primarily disabled were weaned from VV-ECMO upon recovery from respiratory failure and were ambulatory at the time of discharge from hospital. The ratio of PaO2/FIO2 (P/F) at 24 h after starting VV-ECMO did not significantly differ between survivors and non-survivors (187.9 ± 57.7 vs. 135.5 ± 20.5, p = 0.10), but tended to be higher in survivors. Non-survivors were significantly older than survivors.
  
  
  CONCLUSIONS
  Patients who develop severe acute respiratory failure after undergoing heart surgery using cardiopulmonary bypass derive a survival benefit from VV-ECMO.
authors: Department of Cardiovascular Surgery, New Tokyo Hospital, 473-1 Nemoto, Matsudo City, Chiba 271-0077, Japan. kinakamurah@gmail.com
authors: Hiromasa
authors: H
authors: Nakamura
authors: Hiroki
authors: H
authors: Yamaguchi
authors: Atsushi
authors: A
authors: Amano
authors: Tatsuya
authors: T
authors: Nakao
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000601:surgery; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*