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DOI: 10.1055/s-0034-1367253
124 cases of Extracorporeal Membrane Oxygenation assisted mechanical resuscitation in non-postcardiotomy patients
Background: Despite all medical advances the survival rate of patients requiring mechanical resuscitation (CPR) remains dismal. A promising and evolving approach seems to be veno-arterial Extracorporeal Membrane Oxygenation assisted CPR (ECPR). Here we report our institutional experience with this new technology in the field of cardiac surgery.
Methods: We retrospectively analyzed a total of 124 consecutive non-postcardiotomy ECPR cases from January 2008 to July 2013.
Results: Mean age of the patient population was 53 ± 16 years (range 2.4 - 81 years, 80% man). Half of the patient population (54%) was referred from surrounding hospitals. 54% of the referrals were transported on vaECMO. In 94%, vaECMO was installed utilizing the femoral vessels percutaneously, which was complicated in 27% of the cases. In 30% a cannulation associated complication occurred (20% leg ischemia, 8% bleeding, 2% others). In 27%, a cardiac surgeon was present at the time of implantation together with a perfusionist. Mean duration of support was 4 ± 4 days (range 0 - 24 days). 76% were treated on cardiac surgical or cardiological intensive care units, and the remaining in different ICUs. Renal failure requiring renal replacement therapy occurred in 40% of the patient population. 62% of the patient population was successfully weaned from ECMO support, 46% survived 30 days post weaning and 42% survived to hospital discharge. There was no difference in survival between patients over and under 65 years (p = 0.83), and there was no difference in mean age between survivors (54 ± 14 years) and non survivors (53 ± 16 years, p = 0.83). Patients suffering from two or more organ failures showed a trend towards a higher mortality (63% compared to 45%, p = 0.08), which was up to 70% in case of cannulation associated complications (p = 0.1). The survival to discharge rate reached 57% in the last two years which was higher without reaching statistical significance compared to the first two years (33%, p = 0.08) of our ECPR program.
Conclusion: The survival rate of ECPR patients at our institution reaches 57% after overcoming a learning phase. These results should encourage other cardiac surgical centers to start or continue an ECPR program. We expect a significant increase in the use ECPR in the future, and cardiac surgical units should play a key role in this interdisciplinary approach of resuscitation.