[Clinical application of extracorporeal membrane oxygenation for severe heart failure during peri-operative period of end-stage cardiopathy].

ABSTRACT

OBJECTIVE: To summarize the clinical effect and experience of extracorporeal membrane oxygenation (ECMO) support for severe heart failure during peri-operative period of end-stage cardiopathy. METHODS: From June 2007 to July 2010, 6 patients with severe heart failure during peri-operative period of end-stage cardiopathy received ECMO support. The changes in the hemodynamics and outcome of the patients during the use of ECMO were investigated. RESULTS: The duration of ECMO assistance ranged from 23 to 168 hours with a mean of 78 hours. The hemodynamics after using ECMO was much improved than before ECMO [mean arterial pressure (mm Hg, 1 mm Hg=0.133 kPa) 78.13±8.01 vs. 47.75±5.21, central venous pressure ( mm Hg ) 11.03±3.21 vs. 19.36±4.51, cardiac output (L/min) 4.93±1.01 vs. 3.50±0.81, cardiac index (L×min(-1)×m(-2)) 2.71±0.51 vs. 1.91±0.40, pulmonary artery wedge pressure ( mm Hg ) 12.72±6.52 vs. 20.22±6.91, venous oxygen saturation 0.66±0.13 vs. 0.54±0.07], and the amount of using inotropic drug was significantly reduced compared with that before ECMO [dopamine (µg×kg(-1)×min(-1)) 5.05±0.85 vs. 14.20±5.05, epinephrine (µg×kg(-1) ×min(-1)) 0.05±0.01 vs. 0.24±0.04, all P<0.05]. All patients were successfully weaned from ECMO. After weaning, 3 patients recovered and discharged, and the hospital discharge rate was 50%, while 3 patients died of multiple organ failure (MOF). Major complication was bleeding, disseminated intravascular coagulation, infection, embolism. CONCLUSION: ECMO is an important extracorporeal method to support life. ECMO is an effective measure of treatment for end-stage cardiopathy patients with peri-operative severe heart failure. It is important to properly select patients for ECMO.