BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to be a viable and effective treatment for patients suffering from refractory cardiogenic shock (rCS), which is associated with high mortality rates. Although ECMO therapy used as short-term mechanical circulatory support (MCS) has shown tremendous growth in its application over the past decade, the complication and mortality rates remain high. This retrospective study analyzes complications associated with VA-ECMO support, evaluates the use of defined protocols at a single center, and examines factors that may contribute to patient complication and mortality. METHODS: This retrospective analysis included 184 patients who were supported with ECMO from September 2014 through March 2018 at Integris Baptist Medical Center (IBMC). Descriptive statistics were generated to analyze baseline characteristics, demographics, complications, and outcomes. RESULTS: Acute myocardial infarct (AMI) was the primary etiology of this cohort (N=40; 22%). The mean age was 55±15 (median 56, range 15-84) years. All patients were inotrope and/or vasopressor dependent prior to ECMO initiation. Mean time on ECMO support was 7.8±7.9 days with median time of 6 days. Total patient days on support were 1,430. Most ECMO cannulations, 97 (52%) were performed within Integris Baptist Medical Center, with 48% done outside the hospital; 38% were performed outside of the hospital by the IBMC ECMO team, and 10.5% were performed by an outside team. Bleeding was noted to be the most common VA ECMO complication [N=41; 22.3%; 0.028 events per patient day (EPPD)]. CONCLUSIONS: A dedicated 24/7 ECMO service using a multidisciplinary team (MDT) and defined protocols in a single center is able to effectively reduce complications due to VA-ECMO support in the sickest of the sick VA-ECMO patients.
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been shown to be a viable and effective treatment for patients suffering from refractory cardiogenic shock (rCS), which is associated with high mortality rates. Although ECMO therapy used as short-term mechanical circulatory support (MCS) has shown tremendous growth in its application over the past decade, the complication and mortality rates remain high. This retrospective study analyzes complications associated with VA-ECMO support, evaluates the use of defined protocols at a single center, and examines factors that may contribute to patient complication and mortality. METHODS: This retrospective analysis included 184 patients who were supported with ECMO from September 2014 through March 2018 at Integris Baptist Medical Center (IBMC). Descriptive statistics were generated to analyze baseline characteristics, demographics, complications, and outcomes. RESULTS: Acute myocardial infarct (AMI) was the primary etiology of this cohort (N=40; 22%). The mean age was 55±15 (median 56, range 15-84) years. All patients were inotrope and/or vasopressor dependent prior to ECMO initiation. Mean time on ECMO support was 7.8±7.9 days with median time of 6 days. Total patient days on support were 1,430. Most ECMO cannulations, 97 (52%) were performed within Integris Baptist Medical Center, with 48% done outside the hospital; 38% were performed outside of the hospital by the IBMC ECMO team, and 10.5% were performed by an outside team. Bleeding was noted to be the most common VA ECMO complication [N=41; 22.3%; 0.028 events per patient day (EPPD)]. CONCLUSIONS: A dedicated 24/7 ECMO service using a multidisciplinary team (MDT) and defined protocols in a single center is able to effectively reduce complications due to VA-ECMO support in the sickest of the sick VA-ECMO patients.
Authors: Veli-Pekka Harjola; Johan Lassus; Alessandro Sionis; Lars Køber; Tuukka Tarvasmäki; Jindrich Spinar; John Parissis; Marek Banaszewski; Jose Silva-Cardoso; Valentina Carubelli; Salvatore Di Somma; Heli Tolppanen; Uwe Zeymer; Holger Thiele; Markku S Nieminen; Alexandre Mebazaa Journal: Eur J Heart Fail Date: 2015-03-28 Impact factor: 15.534
Authors: Prashant N Mohite; Javid Fatullayev; Olaf Maunz; Sundip Kaul; Anton Sabashnikov; Alexander Weymann; Diana G Saez; Nikhil P Patil; Bartlomiej Zych; Aron F Popov; Fabio DeRobertis; Toufan Bahrami; Mohamed Amrani; Andre R Simon Journal: Artif Organs Date: 2014-05-02 Impact factor: 3.094
Authors: Faisal Aziz; Christoph E Brehm; Aly El-Banyosy; David C Han; Robert G Atnip; Amy B Reed Journal: Ann Vasc Surg Date: 2013-09-21 Impact factor: 1.466
Authors: Benedikt Schrage; Peter Moritz Becher; Alexander Bernhardt; Hiram Bezerra; Stefan Blankenberg; Stefan Brunner; Pascal Colson; Gaston Cudemus Deseda; Salim Dabboura; Dennis Eckner; Matthias Eden; Ingo Eitel; Derk Frank; Norbert Frey; Masaki Funamoto; Alina Goßling; Tobias Graf; Christian Hagl; Paulus Kirchhof; Danny Kupka; Ulf Landmesser; Jerry Lipinski; Mathew Lopes; Nicolas Majunke; Octavian Maniuc; Daniel McGrath; Sven Möbius-Winkler; David A Morrow; Marc Mourad; Curt Noel; Peter Nordbeck; Martin Orban; Federico Pappalardo; Sandeep M Patel; Matthias Pauschinger; Vittorio Pazzanese; Hermann Reichenspurner; Marcus Sandri; P Christian Schulze; Robert H G Schwinger; Jan-Malte Sinning; Adem Aksoy; Carsten Skurk; Lukasz Szczanowicz; Holger Thiele; Franziska Tietz; Anubodh Varshney; Lukas Wechsler; Dirk Westermann Journal: Circulation Date: 2020-10-09 Impact factor: 29.690