1. EXTRACORPOREAL MEMBRANE OXTGENATION IN THE ELDERLY POST-CARDIOTOMY PATIENTS
ECMO and advanced intensive care
Euro-Elso 2013
Stockholm, Sweden / May 9-11, 2013
INTRODUCTION: An increasing number of elderly patients are being accepted for cardiac surgery. The age limit for the use of extracorporeal membrane oxygenation remains contraversial. The aim of our study was to evaluate the outcomes of the elderly patients of the elderly patients who were treated with ECMO following cardiac surgery in our institution.
PATIENTS AND METHODS: This was a single-centre retrospective study. We reviewed the records of 68 consecutive adult patients who underwent 71 ECMO placement for the treatment of refractory cardiogenic shock or respiratory failure following cardiac surgery from January 1, 2008 to February 28, Indications for cardiac ECMO was inability to wean from cardiolpulmonary bypass or post-cardiotomy heart failure refractory to medical treatment. Indication for pulmonary ECMO was respiratory failure with low arterial PaO2 despite optimization of mechanical lung ventilation. Patients were divided into two groups according their age: group 1 (younger than 70 years) and group 2 (70years and older). Maquett (Rotaflow console and Quadrox PLS oxygenator) and Medtronic (Bio-Pump and I A oxygenator) systems were used for extracorporeal oxygenation.
Vilnius University Hospital Santariškių Klinikos Centre of Heart Surgery
Samalavičius R., Urbonas K, Grazulyte D, Norkiene I, Rucinskas K, Janusauskas V, Kalinauskas G
40% 8
LV EF 30-50
15% 3
LV EF <30
7.5±3
Euroscore
85% 17
Other than CABG
10% 2
Emergency surgery
12±10%
Euroscore (logistic) 5% 1
Creatinin>200µmol/l
Critical preoperative state
Unstable angina
30% 6
Pulmonary hypertension
Recent MI
20% 4
Redo surgery
Neurologic impairment
Peripheral vascular disease
Chronic pulmonary disease
35 % 7
Female gender
65 ± 15
Age (years) %
n=20
Variable
RESULTS: Sixty nine veno-arterial and 2 veno-venous (1 in each group) ECMO placements were performed during this time frame. Forty eight patients (age 55±12 years, male/female ratio 26/22 were designated to group 1 (71% of all patients treated with ECMO). Mean duration of support was 114±71 hours, 29(61%) patients weaned from the device, 13(27%) survived to hospital discharge. In 3 cases reinstitution of ECMO due to worsening condition after initial weaning was performed. Twenty elderly patients (age 75±4 years, male female ratio 12/8) were 151±121 hours on ECMO support. Eleven of them (55%) were weaned from the device and 6(30%) survived to hospital discharge.
CONCLUSION: ECMO is a valuable tool for treating the refractory cardiogenic shock following cardiac surgery for the patients that otherwise would die. ECMO can be effectively used in elderly cardiac surgery patients with outcomes similar to that of the younger patients.
25% 5
Renal replacement therapy
Survived to discharge
41% 9
Weaned from ECMO
100% 22
Thoracic canulation
119 ± 117
ECMO (h)
75% 15
IABP
45%
Reinstitution CPB
116 ± 77
Aortic crossclamp (min)
240 ± 180
CPB (min)
490 ± 320
Time of primary surgery (min)
n=20/22 (patients/ECMO procedures)
Table 1: preoperative risk profile
Table 2: Operative variables and ECMO results
Biopump / I A
Rotaflow / Quadrox PLS
Hours of ECMO support
Figure 1: Duration of ECMO and outcome