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CC BY 4.0 · Surg J (N Y) 2023; 09(01): e44-e51
DOI: 10.1055/s-0043-1761444
Original Article

Survival Outcome in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation Support: Early Experience from a University Hospital in Thailand

Pongsanae Duangpakdee 
1   Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Sasitorn Sakkarat
1   Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
,
Surasak Sangkhathat 
2   Department of Surgery and Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Abstract

Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand.

Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses.

Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p-value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days.

Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Keywords

cardiopulmonary failure - extracorporeal membrane oxygenator - life support


Publication History

Received: 15 November 2022

Accepted: 30 November 2022

Article published online:
13 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bartlett RH, Gazzaniga AB, Fong SW, Jefferies MR, Roohk HV, Haiduc N. Extracorporeal membrane oxygenator support for cardiopulmonary failure. Experience in 28 cases. J Thorac Cardiovasc Surg 1977; 73 (03) 375-386
    CrossrefPubMedGoogle Scholar
  • 2 Ventetuolo CE, Muratore CS. Extracorporeal life support in critically ill adults. Am J Respir Crit Care Med 2014; 190 (05) 497-508
    CrossrefPubMedGoogle Scholar
  • 3 Bartoli CR, Koenig SC, Ionan C. et al. Extracorporeal membrane oxygenation versus counterpulsatile, pulsatile, and continuous left ventricular unloading for pediatric mechanical circulatory support. Pediatr Crit Care Med 2013; 14 (09) e424-e437
    CrossrefPubMedGoogle Scholar
  • 4 Chiumello D, Brochard L, Marini JJ. et al. Respiratory support in patients with acute respiratory distress syndrome: an expert opinion. Crit Care 2017; 21 (01) 240
    CrossrefPubMedGoogle Scholar
  • 5 de Lange DW, Sikma MA, Meulenbelt J. Extracorporeal membrane oxygenation in the treatment of poisoned patients. Clin Toxicol (Phila) 2013; 51 (05) 385-393
    CrossrefPubMedGoogle Scholar
  • 6 Freed DH, Thomson BM, Berman M. et al. Survival after pulmonary thromboendarterectomy: effect of residual pulmonary hypertension. J Thorac Cardiovasc Surg 2011; 141 (02) 383-387
    CrossrefPubMedGoogle Scholar
  • 7 Takayama H, Truby L, Koekort M. et al. Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant 2013; 32 (01) 106-111
    CrossrefPubMedGoogle Scholar
  • 8 Falk L, Hultman J, Broman LM. Extracorporeal membrane oxygenation for septic shock. Crit Care Med 2019; 47 (08) 1097-1105
    CrossrefPubMedGoogle Scholar
  • 9 Chang W. Extracorporeal life support in organ transplant donors. Korean J Thorac Cardiovasc Surg 2018; 51 (05) 328-332
    CrossrefPubMedGoogle Scholar
  • 10 Shinar Z, Plantmason L, Reynolds J. et al. Emergency physician-initiated resuscitative extracorporeal membrane oxygenation. J Emerg Med 2019; 56 (06) 666-673
    CrossrefPubMedGoogle Scholar
  • 11 Hou X, Guo L, Zhan Q. et al. Extracorporeal membrane oxygenation for critically ill patients with 2009 influenza A (H1N1)-related acute respiratory distress syndrome: preliminary experience from a single center. Artif Organs 2012; 36 (09) 780-786
    CrossrefPubMedGoogle Scholar
  • 12 Assanangkornchai N, Vichitkunakorn P, Bhurayanontachai R. Characteristics and outcomes of severe ARDS patients receiving ECMO in southern Thailand. Clin Med Insights Circ Respir Pulm Med 2019; 13: 1179548419885137
    CrossrefPubMedGoogle Scholar
  • 13 Aubron C, Cheng AC, Pilcher D. et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care 2013; 17 (02) R73
    CrossrefPubMedGoogle Scholar
  • 14 Ali J, Vuylsteke A. Extracorporeal membrane oxygenation: indications, technique and contemporary outcomes. Heart 2019; 105 (18) 1437-1443
    CrossrefPubMedGoogle Scholar
  • 15 Aubron C, DePuydt J, Belon F. et al. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care 2016; 6 (01) 97
    CrossrefPubMedGoogle Scholar
  • 16 Hervey-Jumper SL, Annich GM, Yancon AR, Garton HJ, Muraszko KM, Maher CO. Neurological complications of extracorporeal membrane oxygenation in children. J Neurosurg Pediatr 2011; 7 (04) 338-344
    CrossrefPubMedGoogle Scholar