Venovenous extracorporeal membrane oxygenation is effective against post-cardiotomy acute respiratory failure in adults

Hiromasa Nakamura, Hiroki Yamaguchi, Atsushi Amano, Tatsuya Nakao
General Thoracic and Cardiovascular Surgery 2013, 61 (7): 402-8

BACKGROUND: Acute respiratory failure is a serious issue that occasionally occurs after weaning from cardiopulmonary bypass (CPB) after heart surgery. This condition can be refractory to mechanical ventilation and the mortality rate is high. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is applied to treat acute lung failure after CPB at our institution. This report describes the use of VV-ECMO after cardiac surgery at a single institution.

METHODS: We analyzed the outcomes of 11 patients who developed severe acute respiratory failure requiring VV-ECMO after undergoing heart surgery with a cardiopulmonary bypass.

RESULTS: Four (36.4%) patients died in hospital. One patient required conversion from VV- to venoarterial (VA-) ECMO because of circulatory instability. One patient each died of respiratory failure and heart failure and two died of ischemic colitis. Lung damage secondarily developed in these four patients to other disabled organs. Seven (63.6%) patients whose lungs were primarily disabled were weaned from VV-ECMO upon recovery from respiratory failure and were ambulatory at the time of discharge from hospital. The ratio of PaO2/FIO2 (P/F) at 24 h after starting VV-ECMO did not significantly differ between survivors and non-survivors (187.9 ± 57.7 vs. 135.5 ± 20.5, p = 0.10), but tended to be higher in survivors. Non-survivors were significantly older than survivors.

CONCLUSION: Patients who develop severe acute respiratory failure after undergoing heart surgery using cardiopulmonary bypass derive a survival benefit from VV-ECMO.

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