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J Crit Care. 2018 Apr;44:31-38. doi: 10.1016/j.jcrc.2017.10.011. Epub 2017 Oct 12.

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support.

Author information

1
Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver General Hospital, Rm 330, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada. Electronic address: terri.sun@alumni.ubc.ca.
2
Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, V6T 1Z3 Vancouver, British Columbia, Canada.
3
Perfusion Services, Vancouver General Hospital, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada.
4
Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver General Hospital, Rm 330, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada; Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Critical Care, Vancouver General Hospital, 2438-855 West 12th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada.
5
Department of Emergency Medicine, University of British Columbia, Rm 3300, 910 W 10th Ave, V5Z 1M9 Vancouver, British Columbia, Canada.
6
Cardiac Services BC, Provincial Health Services Authority, 700-1380 Burrard Street, V6Z 2H3 Vancouver, British Columbia, Canada.
7
Cardiovascular Surgery, Faculty of Medicine, University of British Columbia, Cardiac Surgery, Vancouver General Hospital, 950 West 10th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada.
8
Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, V6T 1Z3 Vancouver, British Columbia, Canada; Department of Medicine, Division of Critical Care, Faculty of Medicine, University of British Columbia, Critical Care, Vancouver General Hospital, 2438-855 West 12th Avenue, V5Z 1M9 Vancouver, British Columbia, Canada.

Abstract

PURPOSE:

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may provide benefit to patients in refractory cardiac arrest and cardiogenic shock. We aim to summarize our center's 6-year experience with resuscitative VA-ECMO.

MATERIALS AND METHODS:

A retrospective medical record review (April 2009 to 2015) was performed on consecutive non-cardiotomy patients who were managed with VA-ECMO due to refractory in- or out-of-hospital cardiac (IHCA/OHCA) arrest (E-CPR) or refractory cardiogenic shock (E-CS) with or without preceding cardiac arrest. Our primary outcome was survival to hospital discharge and good neurological status (Cerebral Performance Category 1-2).

RESULTS:

There were a total of 22 patients who met inclusion criteria of whom 9 received E-CPR (8 IHCA, 1 OHCA) and 13 received E-CS. The median age for E-CPR patients was 52 [IQR 45, 58] years, and 54 [IQR 38, 64] years for E-CS patients. Cardiac arrest duration was 70.33 (SD 39.56) min for the E-CPR patients, and 24.67 (SD 26.73) min for the 9 patients treated with E-CS who had previously arrested. Initial cardiac arrest rhythms were pulseless electrical activity (39%), ventricular fibrillation (33%), or ventricular tachycardia (28%). A total of 18/22 patients were successfully weaned from VA-ECMO (78%); 16 patients survived to hospital discharge (73%) with 15 in good neurological condition.

CONCLUSION:

The initiation of VA-ECMO at our center for treatment of refractory cardiac arrest and cardiogenic shock yielded a high proportion of survivors and favorable neurological outcomes.

KEYWORDS:

Cardiac arrest; Cardiogenic shock; E-CPR; E-CS; ECLS; Extracorporeal cardiopulmonary resuscitation; Extracorporeal life support; VA-ECMO; Veno-arterial extracorporeal membrane oxygenation

PMID:
29040883
DOI:
10.1016/j.jcrc.2017.10.011

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