The use of extracorporeal membrane oxygenation in adult cardiac surgery in a clinic in the development of cardiac or respiratory failure in the early postoperative period

Recently a number of patients with severe cardiovascular disease has increased recently significantly. Also a number of complex and often traumatic open-heart surgery, leading to ischemia and reperfusion damage to cells and tissues. At the same time, there is significantly increasing contingent of patients with concomitant diseases of other organs, which can lead to the development of multiple organ dysfunction syndrome in the first hours after the operation. Extracorporeal membrane oxygenation (ECMO) allows to provide temporary support to the life of patients with potentially reversible cardiac and/or pulmonary insufficiency by using artificial blood circulation and gas exchange.

Objective. The aim of study is to share experience of using ECMO in adult patients after open-heart surgery in the development of cardiac and/or respiratory failure in postperfusion or early postoperative period in our hospital since 1999 to 2016.

Material and methods. Study design – a retrospective analysis. The patient data were obtained from an analysis of medical records, and dynamic monitoring was conducted on the basis of accounting outpatients. Median age of the patients – 47 (31; 64) years, the average weight – 84±23 kg, BSA – 2.52±0.9 m2. 17 patients had ischemic heart disease (IHD), 47 – different valve pathology, 15 – combined pathology (IHD + valves disease), 2 – continuous form of atrial fibrillation, 1 – right atrial trombosis (n=82). Duration of extracorporeal circulation ranged from 80 to 634 min, average duration was 318±122 min. Average period of aortic cross-clamping lasted for 98±32 min (minimum 35 min, maximum 210 min).

Results. Average duration of ECMO support was 4.6±2.9 days. 36.6% of patients have been successfully disconnected from ECMO, 18 patients (22%) discharged from the hospital in satisfactory condition. The mortality rate was 78%. Predictors of intrahospital mortality were: bleeding, low cardiac output syndrome, high levels of lactate. The most frequent complications were: renal failure (21%) and intracranial hemorrhage (11%), resistant myocardial failure (23%), reoperation due to bleeding (19%), sepsis (11%), intravascular coagulation (14%). Predictors of a favorable outcome of the treatment were higher values of hemoglobin, platelets, low levels of lactate and an adequate diuresis.

Conclusions. The use of ECMO technique allows to fully or partially replace the pumping function of the heart and/or lung gas exchange function that provides the optimal level of blood circulation and metabolism in the patient’s body for a long time.