Clinical Study Of Extracorporeal Membrane Oxygenation In Fuwai Hospital

ObjectiveRetrospectively summarized and analyzed the early outcome and long-term outcome of 107 consecutive extracorporeal membrane oxygenation(ECMO) cases performed in Fuwai Hospital and determine specific predictors of survival.MethodsReviewed the clinical protocols of 107 ECMO from Dec.2004 to Dec.2008 in Fuwai Hospital.The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique.All patients were applied veno-artery ECMO and activated clotting time(ACT) was maintained between 120～180 sec and heparin usage dose was 5～20U/(Kg·h).Mean blood flow was 40～220ml/(Kg·min) during ECMO assistant period.ResultsWe support 107 patients(age range 5days～76 years,median age 28.86±25.20 years;weight range 3.2～100 kg,medianweight 43.49±29.04 kg) with extracorporeal membrane oxygenation.The shortest ECMO time was 12 hrs and the longest was 504 hrs with mean time was 128.86±86.64 hrs.68 patients(63.6%) weaned off successfully from ECMO.62 of them were discharged and 6 died of post-operative complications.45 patients could not weaned off from ECMO.Total survival discharge rate was 57.9%.The survival discharge rate is significantly higher in patients whose ECMO indication is failure to withdraw from cardiopulmonary bypass and pulmonary hypertension.Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients(P =0.005).MAP before ECMO in survived patients was significantly higher than that of dead patients(P=0.038).Weights and ECMO duration between the survival and the dead also had statistic difference(P=0.001 and 0.009 separately).Bleeding,renal failure,hemolysis,infection,lower limb ischemia,MSOF,DIC,Oxygenator plasma leakage are the complications significantly related to the dead.The follow up study that used telephone interviews found that 6 case missing and 7 patients died while other 49 patients alive after clischarged.ConclusionsECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery.Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are still the key point of success of ECMO. ObjectiveTo retrospectively summarize and analyze the files of consecutive 45 pediatric ECMO performed in Fuwai Hospital.MethodsWe reviewed the clinical protocols of 45 pediatric ECMO after cardiac surgery from Dec.2004 to Dec.2008 in our hospital.All patients applied veno-artery ECMO and active clotting time(ACT)maintained between 140～180sec and heparin usage dose was 5～20 U /(kg·h).Mean blood flow was 40～220 ml /(kg·min)during ECMO assistant period.ResultsThe shortest ECMO time was 16h and longest 504h and mean time 152h.ECMO were weaned off successfully in 22 patients and 20 of them were survival to discharged and 2 of them were died of persistent cardiopulmonary failure or post-operation complications.23 patients could not been weaned off ECMO.Total survival discharge rate was 44.4%(20/45)in this cohort study.Mean age and weight in survived patients was significantly higher than that of dead patients.ECMO duration and complications(renal failure,infection,oxygenator plasma leakage) between the survivors and the nonsurvivors also had statistic difference.The follow up study that used telephone interviews found that 2 case missing and 2 patients died while other 16 patients alive after discharged.ConclusionsECMO is an effective mechanical assistant therapy for cardiac and pulmonary failure patients after cardiac surgery with pediatric complicated congenital heart disease.Perfect correction of abnormality and earlier usage of ECMO for cardiac and respiratory failure patients and avoiding the main organs from irreversible injury are still the key of success of ECMO. ObjectiveTo summarize the clinical experience of extracorporeal membrane oxygenation(ECMO) support for end-stage cardiopathy(ESC) in our hospital.MethodsFrom Jul.2005 to Dec.2008,ECMO support for ESC was performed in 17 patients(13 with end-stage cardiomyopathy,2 with coronary heart disease, 2 with post valve replacement,male 13,female 4,15～67 years old,weight 42.5～100kg).All patients developed refractory cardiogenic shock and/or acute pulmonary dysfunction.The ECMO cannulation was performed through femoral vessels.The patients were sedatived or conscious during ECMO. Hemodynamic and respiratory parameters were made stably.ResultsMean duration of ECMO was 125.5 hours(20～416hours).16 patients were successfully weaned from ECMO,15 patients of which survived.1 patient could not wean form ECMO.The follow up study that used telephone interviews found that 2 patients died while other 13 patients alive after discharged.ConclusionECMO is an effective technique of treatment on ESC patients with refractory cardiogenic shock and acute pulmonary dysfunction.It can prolong some ESC Datients' lives. ObjectiveThe complications associated with extracorporeal membrane oxygenation (ECMO)can be classified into mechanical and patient—medical complications.Mechanical complications include oxygenator failure,tubing clots,pump and heat exchanger malfunction.Patient—related medical problems are bleeding,neurological complications,organ failure and infection.The objective of this study was to retrospectively investigate and analyze the data of 107 consecutive ECMO cases performed in Fuwai Hospital.MethodsThe author reviewed clinical records of the ECMO patients in Fuwai Hospital from Dec.2004 to Dec.2008.A total of 107 patients with the ECMO supported in our hospital were studied for the incidence of complications.The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique.All patients were applied veno-artery ECMO and activated clotting time(ACT) was maintained between 120～180 sec and heparin usage dose was 5～20U/(Kg·h).Mean blood flow was 40～220ml/(Kg·min) during ECMO assistant period.ResultsWe support 107 patients(age range 5days～76 years,median age 28.86±25.20 years;weight range 3.2～100 kg,median weight 43.49±29.04 kg) with extracorporeal membrane oxygenation.68 patients(63.6%) weaned off successfully from ECMO.62 of them were discharged and 6 died of post-operative complications.45 patients could not weaned off from ECMO. Total survival discharge rate was 57.9%.They suffered the complications, such as bleeding,infection,renal failure,neurological complications,MSOF, limb ischemia and oxygenator plasma leakage with the incidence of 32.7%, 11.2%,28.3%,7.48%,5.61%,8.41%and 30.8%respectively.Bleeding, renal failure,hemolysis,infection,limb ischemia,MSOF,DIC and oxygenator plasma leakage are significantly related to nonsurvival rate.ConclusionsGenerally,the risk of complications increases with the duration of time on ECMO support.Bleeding and oxygenator plasma leakage are the most important complications of ECMO.During the ECMO treatment,it is also important of prevent from the complications.Once they occur,active therapies must be carried out to save the patients lives.