title: Central closed chest implantation of extracorporeal membrane oxygenation to prevent limb ischemia.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) support is a widely accepted treatment option for patients with cardiogenic shock, but it is still related to a high incidence of severe complications and death. We present an alternative implantation technique to prevent life-threatening vascular complications.
  
  
  METHODS
  Between January 2008 and January 2011, a total of 28 patients with acute myocardial failure and consecutive cardiogenic shock required ECMO as supportive treatment. Pre-implantation procedures were isolated CABG, CABG combined with mitral valve reconstruction or ventricular septal defect closure, respectively. The implantation of ECMO was performed by connecting the ascending aorta via an 8 mm Dacron prosthesis with the arterial line and percutaneous puncture of the femoral vein. The chest was closed after installation of ECMO was completed. The arterial line was directed subxyphoidally and removal was possible without thoracotomy.
  
  
  RESULTS
  Average support duration was 8.7 ± 3.9 days. An additional intra-aortic balloon pump was used in 23 patients (89.3%). Cerebrovascular events occurred in 21.4% and gastrointestinal complications in 9.1%. Acute renal failure was treated with continuous renal replacement therapy in 64.3%. In eight cases a systemic infection had to be treated. One patient with pre-existing severe peripheral arterial disease suffered from limb malperfusion, requiring leg amputation. Twelve patients were successfully weaned from ECMO and 8 patients (28.6%) were discharged from hospital.
  
  
  CONCLUSIONS
  This alternative cannulation strategy offers effective cardiopulmonary support while minimizing the risk of limb hypo- or hyperperfusion without requiring reopening of the thorax.
authors.affiliation: Department for Cardiothoracic Surgery, Heart and Vessel Center Bad Bevensen, Bad Bevensen - Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Deschka
authors.forename: Matthias
authors.initials: M
authors.lastname: Machner
authors.forename: Salah
authors.initials: S
authors.lastname: El Dsoki
authors.forename: Aiman
authors.initials: A
authors.lastname: Alken
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D007511:Ischemia / Q000517:prevention & control*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome