Extracorporeal membrane oxygenation applied patients review: Four years results

Extracoporeal membrane oxygenarator usage is widely raising after cardiogenic shock and cardiac arrest. The primary outcome for this study is to share a 4 year results of the patients whom we applied VA ECMO for cardiac reasons. The secondary outcomes are the effects of the parameters that we scan, to 1 and 6 month survival. Sixty nine patients needed ECMO between January 2012 and December 2015 and we applied VA ECMO for cardiac reasons to 46 of these patients. We applied 7 (%15.2) of them centrally via right atrium to ascending aorta and 39 of them periferally via femoral vein to artery. In our clinic we are using the brands Medos and Macque which are centifugal pumps. While we are using periferic ways, we always applied it with USG guidance and then checked the places of the cannules with USG, too. All 46 patients were supported by VA ECMO due to cardiac problems and 30 (%65) of them were applied during or after the cardiac surgery, 16 (%35) of them were applied in non-operatif circumstances. 14 (%30.4) of the patients weaned from ECMO with success, but 32 (%69.6) of them ended with exitus despite ECMO support. 20 of the patients had also another cardiac support rather than ECMO. 8 (%40) of them had left ventricular assit device and 12 (%60) of them had heart transplantation besides ECMO support. Thirty one (%67.4) of the patients are male and 15 (%32.6) of them are female. The average age of the patients is 47.7 ± 20.9 (minimum 11, maximum 83). The average body mass index is 26.1 ± 6.4 kg/m2 (minimum 15.5 kg/m2, maximum 39.2 kg/m2) and 12 (%26) of them are obese (BMI >30 kg/m2). At the acceptance of the 46 patients to the ICU, the average APACHE - 2 score is 19.6 ± 6.2 and the average RESP score is -2.9 ± 4.2 (minimum -14, maximum 4). We initiated ECMO support to the patients with the average of 83.6 ± 184.9 (minimum 0, maksimum 980) hours after the addmission to the ICU and the average ECMO duration is 226.9 ± 283.4 (minimum 12, maximum 1440) hours. The average 4th hour ECMO flow of 46 patients is 2.8 ± 0.7 (minimum 1.17, maximum 4.10) lt/min. 2 patients died in 24 hours just after the ECMO was applied so, the rest of the 44 patients' average 24th hour ECMO flow is 3.2 ± 0,8 (minimum 1.34, maximum 4.5) lt/min. Many complications occured due to various reasons in 36 (%78.3) patients whom we applied VA ECMO to. 26 (%56.5) of them had hemoragic, 15 (%32.6) of them had neurologic, 14 (%30.4) of them had renal, 6 (%13) of them had metabolic, 7 (%15.2) of them had pulmonary and 4 (%8.7) of them had mechanic complications due to ECMO administiration. During ICU stay, we determined one or more microorganism proliferation on cultures that we had taken from different parts of the 32 (%69.6) patients. We determined microorganisms on; DTA cultures of 30 (%65.2) patients, central venous blood cultures of 23 (%50) patients, arterial blood cultures of 11 (%23.9) patients, urine cultures of 9 (%19.6) patients, cotton swap cultures taken from different skin parts of 8 (%17.4) patients, sputum cultures of 4 (%8.7) patients and periferic venous culture of 1 (%2.8) patient. We detected acinetobacter sp. in 26 (%56.5) patients, E.Coli in 19 (%41.3) patients, klebsiella sp. in 11 (%23.9) patients, enterococcus sp. in 10 (%21.7) patients, staphilococcus sp. in 10 (%21.7) patients, pseudomonas sp. in 7 (%15.2) patients, candida sp. in 2 (%4.3) patients, proteus sp. in 2 (%4.3) patients and serratia sp. in 1 (%2.8) patient. Our 30 days survival is % 41 and 6 months survival is % 20. We have researched the effects of the variables which we scaned for this study to the 30 days and 6 months survival. Then the results were compared with the available literature and their prognostic value on patients treatment was evaluated. Recently, extracorporeal membrane oxygenarator has become a credible alternative to medical and mechanical support treatments used for cardiogenic shock in ICU. The more it is used in big numbers in ICU departments, the more reliable data regarding ECMO will be available which will demostrate its role in cardiogenic shock and cardiac arrest treatment more clearly.