The Use of Extra Corporeal Membrane Oxygenator (ECMO) is Becoming a Routine Working Tool in Emergency Cardiac or Respiratory Failure

Introduction:

ECMO is an important resuscitative and supportive measure for patients with extreme cardiac or respiratory failure. Worldwide some 3,000 ECMOs in 300 institutes are installed annually.

Our objectives are to show the rapid growth of the use of ECMO in our institution, to present the clinical results, and to emphasize the importance of this life saving instrument.

Patients and Methods:

ECMO support was used in 39 adult patients (pts) during 2017, a number equal to the total number of pts supported during the previous 4 years (2013 – 2016).

Indications for ECMO support were post myocardial infarction cardiogenic shock in 9 pts (and additional 5 with out of hospital resuscitation), non-ischemic cardiogenic shock in 3 patients, , failure to wean from cardiopulmonary bypass in 11 pts, , respiratory failure in 5 pts and elective or emergency VT ablation in 6 pts. .

Results:

Time from call to running ECMO was 30 to 60 minutes in all emergency cases. Four of the 9 pts (44.4%) with ischemic cardiogenic shock survived to discharge, as well as 2 of the 5 pts (40%) who underwent out of hospital resuscitation . One of the 3 pts with non-ischemic shock (33%) survived to discharge, as did 2 of the 11 (18.2%) post CPB patients, 2 of the 5 pts (40%) with respiratory failure and 6 out of 6 pts (100%) who underwent VT ablation. Seven patients experienced vascular complications - either bleeding or ischemic limb. Two patients had massive bleeding – intra cranial and GI bleeding and 4 patients had HIT and were switched to Bivalirudine.

Conclusions:

Patients with extreme cardiac or respiratory failure may be saved by ECMO support with encouraging rates of survival to discharge. We believe that this life saving solution should become a routine working tool for cardiac and respiratory emergencies.