Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years?

Abstract

The aim of this study was to provide early and mid-term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge-to-decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid-term overall survival with up to two-year follow-up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO (P = 0.021), mean arterial pressure (P = 0.027), FiO (P = 0.001), lactate (P = 0.001), and pH (P < 0.001). The mean ECMO support duration was 96 ± 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log-Rank (Mantel-Cox) P = 0.374, Breslow (Generalized Wilcoxon) P = 0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable "real world" results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR.

Gender‐related differences in treatment and outcome of extracorporeal cardiopulmonary resuscitation‐patients

“…• Non-shockable rhythm >20 minutes after examination for cardiac tamponade or pulmonary embolism • Hemoglobin <8 g/dL ECMO cannulas were implanted via femoral vessel puncture in Seldinger's technique, as already published by our study group. 12,13 Extracorporeal circulation was established by a Rotaflow centrifugal pump (Maquet, Rastatt, Germany) with a Quadrox membrane oxygenator (Maquet) and the PLS2050 circuit system (Maquet).…”

Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients

“…Tissue microdialysis was not conducted due to its invasiveness and costs. Main characteristics, criteria and technique of vaECMO assistance in neonatal and pediatric patients have been published in detail in previous studies [7][8][9][10][11]. Target activated clotting time was 160-180 s, whereas activated partial thromboplastin time (aPTT) was maintained by 60-80 s., based on daily controls if there was no active bleeding tendency.…”

CPR and ECMO: The Next Frontier

“…88 More than half of cardiac arrest victims do not have ROSC, even with use of ECMO. [19][20][21]89 In addition, a substantial number of patients with ROSC will be brain dead, despite the use of ECMO. Patients with ongoing ECMO, but without ROSC, or with brain death, represent a large pool of viable donors, since it has been shown that kidneys and livers from donors on ECMO, but with brain death, had similar survival to those not on ECMO.…”