Utilización de oxigenación por membrana extracorpórea venoarterial en el shock cardiogénico y paro cardiorrespiratorio refractarios: experiencia inicial de 7 años en un centro de cardiología de adultos: pp. 422-428

Leonardo A. Seoane; Lucrecia M. Burgos; Juan F. Furmento; Walter García; Pablo Spaletra; Mariano Vrancic; Juan P. Costabel; Mariano N. Benzadón; Daniel O. Navia; Mirta Diez

doi:10.7775/rac.es.v89.i5.20436

Authors

Leonardo A. Seoane ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0002-2039-5199
Lucrecia M. Burgos ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0002-3999-1265
Juan F. Furmento ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0002-6818-9634
Walter García ICBA Instituto Cardiovascular, Buenos Aires, Argentina.
Pablo Spaletra ICBA Instituto Cardiovascular, Buenos Aires, Argentina.
Mariano Vrancic ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0002-4518-2085
Juan P. Costabel ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0003-0073-5739
Mariano N. Benzadón ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0003-4073-5098
Daniel O. Navia ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0001-8319-1399
Mirta Diez ICBA Instituto Cardiovascular, Buenos Aires, Argentina. https://orcid.org/0000-0003-3916-1496

DOI:

https://doi.org/10.7775/rac.es.v89.i5.20436

Keywords:

Extracorporeal Membrane Oxygenation, Cardiogenic shock, Postcardiotomy shock, Ventricular assist devices

Abstract

Background: Venoarterial extra corporeal membrane oxygenation (VA-ECMO) is a rescue intervention used in patients with cardiogenic shock (CS) or cardiac arrest (CA) refractory to conventional medical therapies.

Objective: The aim of the present study is to describe the characteristics and summarize our 7-year experience in patients with CS or CA supported with VA-ECMO.

Methods: We conducted a single-center retrospective study analyzing consecutive adult patients requiring VA-ECMO due to refractory CS or CA at ICBA, Instituto Cardiovascular between January 2014 and December 2020.

Results: A total age 54 patients were included (54 ±12 years), 36.5% presented ischemic cardiomyopathy and 23.1% significant valvular heart disease. The indications for VA-ECMO implantation were post-cardiotomy (43.4%), refractory CS (28.3%) and primary graft dysfunction (20.8%). Cardiopulmonary resuscitation before VA-ECMO occurred in 18.5% of the cases. Peripheral cannulation was performed in 81.5% o the cases, 83.3% had INTERMACS profile 1 and 87% were on intraaortic balloon pump. Duration of ventricular assistance on VA- ECMO was 5.5 days (IQR 2.8-10). Survival rate on ECMO VA was 63% (37% as a bridge to cardiac transplantation and 26% as a bridge to recovery) and survival to discharge was 42.6%. The most common complications were hemorrhage (61.1%), infections (51.9%), and thromboembolic complications (46.3%).
Conclusion: In our center, VA-ECMO as a treatment for refractory CS or CA showed acceptable survival during ventricular support and on hospital discharge. It is an effective life support treatment to rescue critically ill patients when conventional therapies fail, is apparently useful and can be implemented in a country with limited resources and access to complex ventricular assist devices.

How to cite this article:

Seoane LA, Burgos LM, Furmento JM, García W, Spaletra P, Vrancic M, et al. Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock and Cardiac Arrest: An Initial 7-Year Experience in an Adult Cardiology Center. Rev Argent Cardiol 2021;89:404-409.

http://dx.doi.org/10.7775/rac.v89.i5.20436