Twelve years of circulatory extracorporeal life support at the University Medical Centre Utrecht

Abstract

Introduction Circulatory extracorporeal life support (ECLS) has been performed at the University Medical Centre Utrecht for 12 years. During this time, case mix, indications, ECLS set-ups and outcomes seem to have substantially changed. We set out to describe these characteristics and their evolution over time. Methods All patients receiving circulatory ECLS between 2007 and 2018 were retrospectively identified and divided into six groups according to a 2-year period of time corresponding to the date of ECLS initiation. General characteristics plus data pertaining to comorbidities, indications and technical details of ECLS commencement as well as in-hospital, 30-day, 1‑year and overall mortality were collected. Temporal trends in these characteristics were examined. Results A total of 347 circulatory ECLS runs were performed in 289 patients. The number of patients and ECLS runs increased from 8 till a maximum of 40 runs a year. The distribution of circulatory ECLS indications shifted from predominantly postcardiotomy to a wider set of indications. The proportion of peripheral insertions with or without application of left ventricular unloading techniques substantially increased, while in-hospital, 30-day, 1‑year and overall mortality decreased over time. Conclusion Circulatory ECLS was increasingly applied at the University Medical Centre Utrecht. Over time, indications as well as treatment goals broadened, and cannulation techniques shifted from central to mainly peripheral approaches. Meanwhile, weaning success increased and mortality rates diminished.

Cardiac tamponade during venoarterial extracorporeal membrane oxygenation: a case report

“…Dissecting this differential diagnosis during VA ECMO support is pivotal as cardiac tamponade can manifest as a reversible cause of persistent VA ECMO dependency. This seems especially relevant as indications for VA ECMO applications are broadening and its use is steadily growing [ 7 ].…”

Initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock during out of hours versus working hours is not associated with increased mortality

“…For this study, we analyzed patients who had been recruited into the Utrecht-ECLS study, details of which have been published previously. 10 In short, all patients who received VA-ECMO in the University Medical Center Utrecht between January 2009 and March 2020 were retrospectively included. Demographics, comorbidities, VA-ECMO indication, date and time of initiation, date of admission to the ICU, and time of death were extracted from the medical chart.…”

The ABCDE approach to difficult weaning from venoarterial extracorporeal membrane oxygenation

“…Patients who ultimately receive an LVAD in the setting of VA ECMO weaning failure have a 30-day survival of 77 percent which drops to about 50 percent after 1 year [18]. This last number approximates overall survival of VA ECMO-supported patients [15].…”

“…This so-called ECMO gap seems largely explained by persistent multiorgan failure, adverse neurological events, bleeding, intercurrent infections (most notably pneumonia) and decompensated cardiac failure [14]. An additional 10 percent of patients ultimately die after hospital discharge but before 1-year follow-up [15]. This seems mainly attributable to underlying disease states, as well as the acquired frailty after a prolonged and complicated intensive care stay [16].…”

“…Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become increasingly used for the urgent and potentially lifesaving support of patients with severe cardiorespiratory failure [1,2]. This increase in popularity may be attributable to improving mortality rates and growing ease of VA ECMO initiation [3].…”