Abstract
Objective – to analyze the experience of using extracorporeal membrane oxygenation (ECMO) after cardiac surgery, to evaluate the advantages and disadvantages of central and peripheral cannulation, to assess the need for left ventricular drainage during venoarterial (VA) ECMO in newborns and children.
Material and methods. The study design is a retrospective analysis. Patient data were obtained from the analysis of case records, and dynamic observation was carried out on the basis of outpatient cards. The study included data on 33 patients (25 newborns and 8 children) operated on at the Bakoulev National Medical Research Center for Cardiovascular Surgery 2022–2024 for complex congenital heart defects, for whom the ECMO method was used in the complex therapy of severe postcardiotomy heart failure in the early postoperative period. The median age of patients was 4 (0.3; 14) years, average weight was 17.4 (3; 51) kg, body surface area was 1,34 (0.2; 1.56) m2. The duration of artificial circulation (EC) ranged from 98 to 324 min, averaging 179.2 ± 51.5 min. The average aortic clamping period lasted 78.1 ± 29.1 min. Left ventricular drainage was used only in the group of patients with central cannulation.
Results. The duration of ECMO ranged from 3 to 7 days (75.93 ± 21.85 hours). With the increase in the duration of ECMO, the probability of a favorable outcome significantly decreased (79 ± 37.09 hours). Fifteen (45.5%) patients were successfully disconnected from ECMO, and 11 (33.3%) – were discharged from the hospital in a satisfactory condition. Mortality was 66.4%. Predictors of hospital mortality were: the level of blood loss, low cardiac output syndrome, high lactate concentration. The most common complications were renal failure (27.3%), persistent myocardial insufficiency (42.4%), rethoracotomy for bleeding (24.2%). Predictors of a favorable treatment outcome are higher values of hemoglobin, platelets, low lactate levels and adequate diuresis rate.
Conclusion. The use of the ECMO method allows to completely or partially replace the pumping function of the heart, which ensures an optimal level of blood circulation and metabolic processes in the patient's body for a long time. The installation of a left ventricular drainage is necessary during VA-ECMO to unload the left heart and affects the effectiveness of this method.
References
- Bockeria L.A., Shatalov K.V., Makhalin M.V. Extracorpo-real membrane oxygenation. Monograph. Moscow; 2013 (in Russ.).
- Patsoeva I.M. , Averina I.I., Mironenko M.U., Glushko L.A., Donakanyan S.A. Predictors of the development of heart failure after surgical correction of aortic regurgitation according to stress echocardiography. Bulletin of Bakoulev Center. Cardiovascular Diseases. 2024; 25 (1): 31–40 (in Russ.). DOI: 10.24022/1810-0694-2024-25-1-31-40
- Epting C.L., McBride M.E., Wald E.L., Costello J.M. Pathophysiology of post-operative low cardiac output syndrome. Curr. Vasc. Pharmacol. 2016; 14: 14–23. DOI: 10.2174/1570161113666151014123718
- Zakkar M., Guida G., Suleiman M.S., Angelini G.D. Cardiopulmonary bypass and oxidative stress. Oxid. Med. Cell. Longev. 2015; 2015: 189863. DOI: 10.1155/2015/189863
- Rychin S.V., Yudin G.V., Makhalin M.V., Kokoev M.B. Successful use of extracorporeal membrane oxygenation in a patient with acute postcardiotomy heart failure after correction of acute type A aortic dissection. Grudnaya i Serdechno-Sosudistaya Khirurgiya. 2021; 63 (3): 221–226 (in Russ.). DOI: 10.24022/0236-2791-2021-63-3-221-226
- Lorusso R., Meani P., Raffa G.M., Kowalewski M. Extracorporeal membrane oxygenation and left ventricular unloading: What is the evidence? JTCVS Techniques. 2022; 13: 101–114. DOI: 10.1016/j.xjtc.2022.02.039
- Lorusso R. Are two crutches better than one? The ongoing dilemma of the effects and need of left ventricular unloading during veno-arterial extracorporeal membrane oxygenation. Eur. J. Heart Fail. 2017; 19: 413–415. DOI: 10.1002/ejhf.695
- Russo J.J., Aleksova N., Pitcher I., Couture E., Parlow S., Faraz M. et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J. Am. Coll. Cardiol. 2019; 73 (6): 654–662. DOI: 10.1016/j.jacc.2018.10.085
- Shatalov K.V., Arnautova I.V. Results of the medical and scientific work of the Department of Emergency Surgery for Congenital Heart Defects with the Assisted Circulation Group of the Bakoulev National Medical Research Center for Cardiovascular Surgery for 2022. Bulletin of Baloulev Center. Cardiovascular Diseases. 2023; 24 (3): 231–250 (in Russ.). DOI: 10.24022/1810-0694-2023-24-3-231-250
- Pham T., Combes A., Rozé H., Chevret S., Mercat A., Roch A. et al.; REVA Research Network. Extracorporeal membrane oxygenation for pandemic influenza A(H1N1)-induced acute respiratory distress syndrome: a cohort study and propensity-matched analysis. Am. J. Respir. Crit. Care Med. 2013; 187: 276–285. DOI: 10.1164/rccm.201205-0815OC
- Zangrillo A., Landoni G., Biondi-Zoccai G., Greco M., Greco T., Frati G. et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit. Care Resusc. J. Aust. Acad. Crit. Care Med. 2013; 15 (3): 172–178.
- Bembea M.M., Annich G., Rycus P., Oldenburg G., Berkowitz I., Pronovost P. Variability in anticoagulation management of patients on extracorporeal membrane oxygenation: an international survey. Pediatr. Crit. Care Med. J. Soc. Crit. Care Med. World Fed. Pediatr. Intensive Crit. Care Soc. 2013; 14 (2): e77–84. DOI: 10.1097/РСС. 0b013e31827127e4
- Lee S.W., Yu M.Y., Lee H., Ahn S.Y., Kim S., Chin H.J. et al. Risk factors for acute kidney injury and in-hospital mortality in patients receiving extracorporeal membrane oxygenation. PLoS ONE. 2015; 10: e0140674. DOI: 10.1371/journal.pone.0140674
- Razo-Vazquez A.O., Thornton K. Extracorporeal membrane oxygenation – what the nephrologist needs to know. Adv. Chronic. Kidney Dis. 2016; 23: 146–151. DOI: 10.1053/j.ackd.2016.02.004
About the authors
- Konstantin V. Shatalov, Dr. Med. Sci., Professor, Head of the Department; ORCID
- Maksim V. Makhalin, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
