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Venovenous extracorporeal membrane oxygenation is effective against post-cardiotomy acute respiratory failure in adults

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Abstract

Background

Acute respiratory failure is a serious issue that occasionally occurs after weaning from cardiopulmonary bypass (CPB) after heart surgery. This condition can be refractory to mechanical ventilation and the mortality rate is high. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is applied to treat acute lung failure after CPB at our institution. This report describes the use of VV-ECMO after cardiac surgery at a single institution.

Methods

We analyzed the outcomes of 11 patients who developed severe acute respiratory failure requiring VV-ECMO after undergoing heart surgery with a cardiopulmonary bypass.

Results

Four (36.4 %) patients died in hospital. One patient required conversion from VV- to venoarterial (VA-) ECMO because of circulatory instability. One patient each died of respiratory failure and heart failure and two died of ischemic colitis. Lung damage secondarily developed in these four patients to other disabled organs. Seven (63.6 %) patients whose lungs were primarily disabled were weaned from VV-ECMO upon recovery from respiratory failure and were ambulatory at the time of discharge from hospital. The ratio of PaO2/FIO2 (P/F) at 24 h after starting VV-ECMO did not significantly differ between survivors and non-survivors (187.9 ± 57.7 vs. 135.5 ± 20.5, p = 0.10), but tended to be higher in survivors. Non-survivors were significantly older than survivors.

Conclusion

Patients who develop severe acute respiratory failure after undergoing heart surgery using cardiopulmonary bypass derive a survival benefit from VV-ECMO.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, New Tokyo Hospital, 473-1 Nemoto, Matsudo City, Chiba, 271-0077, Japan

    Hiromasa Nakamura, Hiroki Yamaguchi & Tatsuya Nakao

  2. Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan

    Atsushi Amano

Authors
  1. Hiromasa Nakamura
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  2. Hiroki Yamaguchi
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  3. Atsushi Amano
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  4. Tatsuya Nakao
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Correspondence to Hiromasa Nakamura.

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Nakamura, H., Yamaguchi, H., Amano, A. et al. Venovenous extracorporeal membrane oxygenation is effective against post-cardiotomy acute respiratory failure in adults. Gen Thorac Cardiovasc Surg 61, 402–408 (2013). https://doi.org/10.1007/s11748-013-0226-4

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  • DOI: https://doi.org/10.1007/s11748-013-0226-4

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