COMPARATIVE STUDY
JOURNAL ARTICLE

Switch from venoarterial extracorporeal membrane oxygenation to arteriovenous pumpless extracorporeal lung assist

Bernhard Floerchinger, Alois Philipp, Maik Foltan, Leopold Rupprecht, Alexander Klose, Daniele Camboni, Frank Bruenger, Simon Schopka, Mathias Arlt, Michael Hilker, Christof Schmid
Annals of Thoracic Surgery 2010, 89 (1): 125-31
20103220

BACKGROUND: Extracorporeal membrane oxygenation is an effective rescue tool to treat cardiopulmonary failure. Pumpless systems treat lung failure only; they require adequate cardiac output.

METHODS: We report on 18 patients initially provided with venoarterial extracorporeal membrane oxygenation and then downgraded to a pumpless arteriovenous shunt with a membrane oxygenator by removal of the pump from the circuit after hemodynamic stabilization in the face of persisting pulmonary failure. Main underlying diseases were adult respiratory distress syndrome (44%) and pneumonia (28%). Mean patient age was 44 years, and mean body mass index was 25.7 kg/m(2). Anticoagulation, hemodynamic, and respiratory variables were analyzed.

RESULTS: All patients exhibited severe cardiopulmonary failure with a mean oxygenation ratio (partial pressure of oxygen to fraction of inspired oxygen ratio) of 74 +/- 43 mm Hg (mean partial pressure of oxygen, 70 +/- 33 mm Hg) and a mean partial pressure of carbon dioxide of 68 +/- 32 mm Hg despite maximal (ventilatory) conservative therapy (fraction of inspired oxygen, 0.98 +/- 0.08). Initial serum lactate was 51 +/- 43 mg/dL. The sequential organ failure assessment score averaged 11.8 +/- 2.47, and the lung injury score was 3.1 +/- 0.58. Total mechanical respiratory support was performed for a mean of 13.6 +/- 15.7 days. After 24 hours an improvement in oxygenation and a decrease in carbon dioxide was achieved with a mean partial pressure of carbon dioxide of 40 +/- 11 mm Hg (p < 0.001) and a partial pressure of oxygen of 86 +/- 26 mm Hg (p = 0.031). After 6 +/- 3 days of extracorporeal membrane oxygenation, patients were hemodynamically stabilized. Extracorporeal membrane oxygenation was downgraded to pumpless extracorporeal lung assist for another 10 +/- 15 days (range, 2 to 71 days). Twelve patients (66.7%) could be weaned, with a 30-day mortality of 55.6%. Norepinephrine dosage could be reduced significantly within 24 hours (3.2 +/- 1.8 versus 1.5 +/- 1.5 mg/h; p = 0.008).

CONCLUSIONS: Respiratory support by an extracorporeal device used as last resort therapy allows rapid stabilization of patients with acute lung failure. Early replacement of extracorporeal membrane oxygenation by pumpless extracorporeal lung assist minimizes the negative side effects of extracorporeal circulation.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
20103220
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"