Russian experience of extracorporeal membrane oxygenation usage for treatment of patients with acute respiratory distress syndrome in ECMO-center
Abstract
During last decade a rate of extra of extracorporeal membrane oxygenation (ECMO) use in patients
with acute respiratory distress syndrome (ARDS), refractory to conventional therapy, significantly increased. This life-saving technology is expensive and can results in many complications,
including life-threatening. Based on these health-care systems of many countries have recognized the necessity of organization of specialized ECMO-centers, which would collect patients,
required ECMO. Federal Medico-Biological Agency (FMBA) of the Russian founded ECMO-center at
the tertiary hospital (Burnazian State Research Medical Center) in 2016. The object of the study
was analysis of experience of specialized ECMO-center of FMBA of the Federation in treatment
of patients with ARDS with ECMO.
Material and methods. ECMO was performed with RotoFlow (Maquet, Rastat, Germany) or Cardiohelp (Maquet, Rastat, Germany), cannulas of different size and length were used (Maquet, Rastat,
Germany). Peripheral ECMO started either in the clinic of initial hospitalization, or in our center
after patient transfer. Correction of homeostasis was priority of intensive care during ECMO.
Results. During 11 months of work of ECMO-center of FMBA ECMO was performed in 20 cases. Respiratory V-V ECMO was performed in 8 patients, who were included into the study. Mean age was
42.5 years. There were 5 males and 3 females. ECMO was started in clinic of initial hospitalization
in 5 cases. There were no complications during cannulations or transportation. Duration of ECMO
was 11.9±8.3 days, mechanical ventilation – 19±7.5 days, length of stay in ICU – 22.5±8 days, in
hospital – 34.1±11.6 days. The most frequently complications were nosocomial infection and
hemostasis disorder. Mortality was 37.5%. Immediate causes of death were sepsis and massive
hemorrhage.
Conclusion. The first Russian experience of specialized ECMO-center shows that results of ARDS,
refractory to conventional therapy might be positive, but ECMO should be started timely. Cannulation and patient’s transportation are safe, if they are performed in strong accordance to national and international guidelines and recommendations. Nosocomial infection and hemostasis
disorder are most frequent and serious complications.
Keywords:ECMO, ARDS, community- acquired pneumonia, nosocomial infection, hemostasis disorder, ECMO-center
Clin. Experiment. Surg. Petrovsky J. 2017. N 1. Р. 68–77.
DOI: 10.24411/2308-1198-2017-00023
Received: 01.12.2016. Accepted: 15.01.2017.
References
1. Elicker B.M., Jones K.T., Naeger D.M., et al. Imaging of Acute Lung Injury. Radiol Clin North Am. 2016; Vol. 54: 1119-32.
2. Cardinal-Fernandez P., Correger E., Villanueva J., et al. Acute Respiratory Distress: from syndrome to disease. Med Intensiva. 2016; Vol. 40: 169-75.
3. Gurjar M., Baronia A.K. High frequency oscillatory ventilation for adult ARDS: Is this the end of the road? Anaesthesiol Intensive Ther. 2016; Vol. 48: 272.
4. Chang M., Lu H.Y., Xiang H., et al. Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant intreatment of acute lung injury/acute respiratory distress syndrome in neonates: a comparative analysis. Zhongguo Dang Dai Er Ke Za Zhi. 2016; Vol. 18: 1069-74.
5. Montisci A., Maj G., Zangrillo A., et al. Management of refractory hypoxemia during venovenous extracorporeal membrane oxygenation for ARDS. ASAIO J. 2015; Vol. 61: 227-36.
6. Mosier J.M., Kelsey M., Raz Y., et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care. 2015; Vol. 19: 431.
7. Lucchini A., De Felippis C., Elli S., et al. Mobile ECMO team for inter-hospital transportation of patients with ARDS: a retrospective case series. Heart Lung Vessel. 2014; Vol. 6: 262-73.
8. Martinez-Briseno D., Torre-Bouscoulet L., Herrera-Zamora J. de J., et al. Clinical characteristics and mortality of influenza A H1N1 and influenza-like illness in Mexico City in the 2013-2014 winter season. Rev Invest Clin. 2016; Vol. 68: 147-53.
9. Naqvi I.H., Mahmood K., Ziaullaha S., et al. Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci. 2016; Vol. 32: 1146-51.
10. Williams D.C., Turi J.L., Hornik C.P., et al. Circuit oxygenator contributes to extracorporeal membrane oxygenation-induced hemolysis. ASAIO J. 2015; Vol. 61: 190-5.
11. Landolfo K., Belli E. An evolving paradigm for adult extracorporeal membrane oxygenation: Should the indications include patients with sepsis? J Thorac Cardiovasc Surg. 2016; Vol. 152: 1479-80.
12. Naesens L., Stevaert A., Vanderlinden E. Antiviral therapies on the horizon for influenza. Curr Opin Pharmacol. 2016; Vol. 30: 106-15.
13. Schuetz P., Briel M., Christ-Crain M., et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis. 2012; Vol. 55: 551-62.
14. Oliver W.C. Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth. 2009; Vol. 13: 154-75.
15. Denson K.W., Bonnar J. The measurement of heparin. A method based on the potentiation of anti-factor Xa. Thromb Diath Haemorrh. 1973; Vol. 30: 471-9.
16. Pattel J.J., Liphik R.J. Systemic lupus-induced diffuse alveolar hemorrhage treated with extracorporeal membrane oxygenation: a case report and review of the literature. J Intensive Care Med. 2012.
17. Lemmer J.H. Jr, Despotis G.J. Antitrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2002; Vol. 123: 213-7.