PMID- 30854314
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220408
IS  - 2225-319X (Print)
IS  - 2304-1021 (Electronic)
IS  - 2225-319X (Linking)
VI  - 8
IP  - 1
DP  - 2019 Jan
TI  - Adult cardiac veno-arterial extracorporeal life support (VA-ECMO): prevention and 
      management of acute complications.
PG  - 66-75
LID - 10.21037/acs.2018.12.09 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been 
      shown to be a viable and effective treatment for patients suffering from 
      refractory cardiogenic shock (rCS), which is associated with high mortality 
      rates. Although ECMO therapy used as short-term mechanical circulatory support 
      (MCS) has shown tremendous growth in its application over the past decade, the 
      complication and mortality rates remain high. This retrospective study analyzes 
      complications associated with VA-ECMO support, evaluates the use of defined 
      protocols at a single center, and examines factors that may contribute to patient 
      complication and mortality. METHODS: This retrospective analysis included 184 
      patients who were supported with ECMO from September 2014 through March 2018 at 
      Integris Baptist Medical Center (IBMC). Descriptive statistics were generated to 
      analyze baseline characteristics, demographics, complications, and outcomes. 
      RESULTS: Acute myocardial infarct (AMI) was the primary etiology of this cohort 
      (N=40; 22%). The mean age was 55+/-15 (median 56, range 15-84) years. All patients 
      were inotrope and/or vasopressor dependent prior to ECMO initiation. Mean time on 
      ECMO support was 7.8+/-7.9 days with median time of 6 days. Total patient days on 
      support were 1,430. Most ECMO cannulations, 97 (52%) were performed within 
      Integris Baptist Medical Center, with 48% done outside the hospital; 38% were 
      performed outside of the hospital by the IBMC ECMO team, and 10.5% were performed 
      by an outside team. Bleeding was noted to be the most common VA ECMO complication 
      [N=41; 22.3%; 0.028 events per patient day (EPPD)]. CONCLUSIONS: A dedicated 24/7 
      ECMO service using a multidisciplinary team (MDT) and defined protocols in a 
      single center is able to effectively reduce complications due to VA-ECMO support 
      in the sickest of the sick VA-ECMO patients.
FAU - Koerner, Michael M
AU  - Koerner MM
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Harper, Michael D
AU  - Harper MD
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Gordon, Christopher K
AU  - Gordon CK
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Horstmanshof, Douglas
AU  - Horstmanshof D
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Long, James W
AU  - Long JW
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Sasevich, Michael J
AU  - Sasevich MJ
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - Neel, James D
AU  - Neel JD
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
FAU - El Banayosy, Aly
AU  - El Banayosy A
AD  - Advanced Cardiac Care and Transplant Institute, Integris Baptist Medical Center, 
      Oklahoma City, OK, USA.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Ann Cardiothorac Surg
JT  - Annals of cardiothoracic surgery
JID - 101605877
PMC - PMC6379202
OTO - NOTNLM
OT  - ECMO complications
OT  - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)
OT  - cardiogenic shock
COIS- Conflicts of Interest: A El Banayosy, MD, D Horstmanshof, MD, and JW Long, MD, 
      PhD are consultants. The other authors have no conflicts of interest to declare.
EDAT- 2019/03/12 06:00
MHDA- 2019/03/12 06:01
PMCR- 2019/01/01
CRDT- 2019/03/12 06:00
PHST- 2019/03/12 06:00 [entrez]
PHST- 2019/03/12 06:00 [pubmed]
PHST- 2019/03/12 06:01 [medline]
PHST- 2019/01/01 00:00 [pmc-release]
AID - acs-08-01-66 [pii]
AID - 10.21037/acs.2018.12.09 [doi]
PST - ppublish
SO  - Ann Cardiothorac Surg. 2019 Jan;8(1):66-75. doi: 10.21037/acs.2018.12.09.