Kahn Judith, Müller Helmut, Marte Wolfgang, Rehak Peter, Wasler Andrä, Prenner Günther, Tscheliessnigg Karlheinz
Department of Transplant Surgery, Division of Surgery, Medical University of Graz, Graz, Austria.
J Cardiothorac Vasc Anesth. 2007 Jun;21(3):384-7. doi: 10.1053/j.jvca.2006.12.022. Epub 2007 Mar 21.
Although extracorporeal membrane oxygenation (ECMO) is well established for respiratory failure in neonates, application in adults is still considered controversial. The survival of patients with acute respiratory distress syndrome and ECMO therapy is 50% to 70%.
A retrospective analysis of 10 patients, who were placed on ECMO from September 2004 to December 2005, was performed.
University clinic.
Venoarterial ECMO was established in 7 patients, venovenous ECMO in 2 patients, and combined venoarterial and venovenous ECMO in 1 patient.
Indications were pneumonia, acute respiratory distress syndrome, near drowning, pericardial tamponade with shock lung, right-heart failure after heart transplantation, shock lung after cardiopulmonary resuscitation, and right-heart failure in chronic thromboembolic pulmonary hypertension. Median maintenance of ECMO therapy was 56.5 hours (range, 36-240). The median Murray score was 3.3 for survivors and 4 for nonsurvivors. Overall mortality was 30%; 70% were weaned from ECMO and survived until discharge. Median pre-ECMO risk for fatal outcome according to Hemmila was 0.43 for survivors and 0.92 for nonsurvivors (p < 0.02). In 2 cases, surgical reintervention was necessary because of bleeding in one, and a side switch of the cannulae had to be performed because of femoral venous thrombosis in the other.
ECMO has been shown to be a successful therapy for acute respiratory distress syndrome when conventional strategies have failed. Pre-ECMO risk assessment may be useful in the evaluation of patients.
