Results of extracorporeal life support implementation in routine clinical practice: single center experience

Abstract

AimTo describe our experience in the clinical application of extracorporeal life support (ECLS) and analyze whether ECLS leads to acceptable clinical outcomes in patients with cardiac failure.MethodsData from clinical database of University Hospital Center Zagreb, Croatia, on 75 patients undergoing ECLS support from 2009 to 2014 due to cardiac failure were retrospectively analyzed. Outcomes were defined as procedural and clinical outcomes. ECLS as a primary procedure and ECLS as a postcardiotomy procedure due to inability to wean from cardiopulmonary bypass were analyzed.ResultsECLS was used in 75 adult patients, and in 24 (32%) of those procedural success was noted. ECLS was implemented as a primary procedure in 36 patients and as a postcardiotomy procedure in 39 patients. Nine out of 39 (23.08%) patients had postcardiotomy ECLS after heart transplantation. Bleeding complications occurred in 30 (40%) patients, both in primary (11/36 patients) and postcardiotomy group (19/39 patients). ECLS was established by peripheral approach in 46 patients and by central cannulation in 27 patients. In 2 patients, combined cannulation was performed, with an inflow cannula placed into the right atrium and an outflow cannula placed into the femoral artery. Eleven patients treated with peripheral approach had ischemic complications.ConclusionECLS is a useful tool in the treatment of patients with refractory cardiac failure and its results are encouraging in patients who otherwise have an unfavorable prognosis.

Review of anticoagulation considerations in extracorporeal membrane oxygenation support

“…6,31,34,35,39,42,43,45,47,[59][60][61][62][63][64][65][66][67][68] The next largest group of studied patients, after the "mixed" medical-surgical population, was exclusively post-cardiotomy patients experiencing cardiogenic shock following cardiac surgery, comprising mostly of general open heart surgery procedures such as coronary artery bypass graft (CABG) and/or valve surgery, but also included a small percentage of patients who were bridged to durable left-ventricular assist devices (LVADs) or heart tra nsplant. 29,36,40,[48][49][50]54,56,[69][70][71][72][73][74][75][76][77][78] The third largest group of patient types was the critically ill medical patients, which comprised of 10 studies within the total selected group. 28,30,41,46,58,[79][80][81][82]…”

“…[41][42][43][45][46][47][48]50,52,54,55 Conventional therapeutic UFH use was present in a larger portion (n = 17) of the studies published. 29,61,62,64,65,70,71,[74][75][76]82,85,[89][90][91][92][93] However, there were 21 trials that experimented with a lower anticoagulation intensity either by lower targets or with intermittent bolus therapy, that is, "conservative use." 6,27,29,[37][38][39][40]44,49,51,53,[56][57][58][59]69,77,78,84,87,88 Within those "conservative-use" trials, the investigators' dosing of anticoagulation was dependent on...…”

“…"in-hospital" survival rates, ICU survival, or "survival-to-discharge" rates. 27,31,34,35,38,39,43,[48][49][50]54,[56][57][58][59]63,65,69,70,74,75,[77][78][79][85][86][87][88]90,91,93 There were 23 studies that reported specific data regarding the "on-ECMO" survival, termed as either "weaned," "decannulation," and/or "ECMO mortality" as examples . 6,[38][39][40]42,44,47,48,50,54,56,59,61,65,74,75,[77][78][79]…”

Proactive or reactive? Best approach to limb ischemia in peripheral venoarterial extracorporeal life support

“…Ipsilateral limb ischemia from arterial occlusion can be found in 13% to 24% of patients undergoing peripheral venoarterial ECLS as a result of the cannula size required to achieve adequate supportive flows and the presence of peripheral arterial disease. [4][5][6][7] Many strategies have been proposed to combat this devastating complication. Most of these strategies revolve around decisions for proactive versus reactive placement of antegrade limb perfusion catheters, the method of deployment, and ongoing monitoring of possible inadequate lower extremity perfusion.…”

Contemporary challenges in the management of advanced heart failure

“…While the focus of the medical and industrial communities on long-term implantable devices is certainly warranted, one should also appreciate the progress made in the domain of supporting the circulation during acute cardiac failure ( 5 , 7 , 8 ). The modern heart failure specialist requires considerable expertise in navigating through the ever-expanding portfolio of available devices.…”