RESUMO
ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) for temporary cardiopulmonary support is one of the most intense and technologically complex therapies offered in medicine. It is a high-risk procedure that requires specific knowledge and technical skills to perform it with good results. Objective: The main goal of this study is to describe our extracorporeal membrane oxygenation (ECMO) training program based on the study of specialized nurses and physicians of a simulation teaching experience, conducted in a pediatric cardiac intensive care unit. The program was developed as a theoretical-practical course with final exam and annual maintenance training sessions, caring for ECMO patients, its implementation and results. Methods: A descriptive study for registered nurses, intensivists, and cardiac surgeons. A self-administered, anonymous, and voluntary survey was conducted to assess the long-term perception about the program. Demographic data to describe the population was required, and questions about satisfaction and confidence in acquired skills and competences were asked. A descriptive statistical analysis was performed; patient survival and complications were compared before and after ECMO program using chi-square test, and P<0.05 was considered statistically significant. Results: Twenty-four training courses were performed for 68 professionals. More than 88% of the professionals considered the course components to be adequate and complete; and 94% felt trained to manage the ECMO circuit. Most valued activities were workshops and clinical cases. Since the implementation of the training program, 88 patients were assisted, with a survival rate at discharge of 58%, higher than in the previous period (P=0.03). Conclusion: More than 80% of the professionals considered the workshops and simulations as the most useful components. Reliance on the circuit care was higher than in training problem scenarios. Since 2013 we assisted 88 patients on ECMO, with a survival rate at discharge of 58%, within international standards results.
RESUMO
Objetivo: Describir resultados de membrana de oxigenación extracorpórea en pacientes con cirugía cardíaca y analizar los factores de riesgos de morbimortalidad. Métodos: Estudio retrospectivo, de pacientes cardíacos con asistencia circulatoria. Se registraron variables, diagnóstico, cirugía, puntaje Risk Adjustment for Congenital Heart Surgery (RACHS), momento de colocación, canulación, días de asistencia en internación, complicaciones, sobrevida y seguimiento. Se analizaron los riesgos edad, peso, RACHS, patología uni- o biventricular, momento de colocación, días de asistencia e internación, y complicaciones. Análisis estadístico descriptivo y de regresión logística para factores de riesgo. Resultados: En 5295 admisiones, 72 pacientes requirieron membrana de oxigenación extracorpórea (1,37 %). Edad mediana: 6,5 meses (rango intercuartilo -RIQ-: 20 días-2 años); peso: 5,5 kg (RIQ: 3,25-9,5); tiempo de bomba: 188 min (RIQ: 134-246,5); de clampeo: 92 min (65-117). La canulación fue en quirófano en 34 casos (47 %). La mediana de asistencia fue 3 días (RIQ: 2-5), y de internación, 20 (RIQ: 11-32). La sobrevida al alta fue 49 %; 8 pacientes fallecieron durante el seguimiento. La complicación más frecuente fue hemorragia ( 57 %). El peso <5 kg (p = 0,01) y vasopresores en asistencia (p = 0,012) tuvieron riesgo de mortalidad. La sobrevida a 10 años fue del 77 %, con 84 % en clase funcional 1-2 y el 37 % presentaba algún grado de retardo madurativo. Conclusiones: La complicación más frecuente fue la hemorragia; peso y vasopresores se asociaron con mortalidad.
Objective: To describe the results of extracorporeal membrane oxygenation in patients undergoing heart surgery and analyze the risk factors for morbidity and mortality. Methods: Retrospective study conducted in cardiac patients under circulatory support. Outcome measures, diagnosis, surgery, Risk Adjustment for Congenital Heart Surgery (RACHS) score, implantation time, cannulation, length of support during stay, complications, survival, and follow-up were recorded. Risks were analyzed in relation to age, weight, RACHS score, single-ventricle or biventricular disease, implantation time, length of support and stay, and complications. Descriptive statistical and logistic regression analyses for risk factors were done. Results: Among 5295 hospitalizations, 72patients required extracorporeal membrane oxygenation (1.37 %). Median age: 6.5 months (interquartile range [IQR]: 20 days-2 years); weight: 5.5 kg (IQR: 3.25-9.5); pump time: 188 min (IQR: 134- 246.5); clamp time: 92 min (65-117). Cannulation was done in the operating room in 34 cases (47 %). The median length of support was 3 days (IQR: 2-5), and of stay, 20 days (IQR: 11-32). Survival at discharge was 49 %; 8 patients died during follow-up. The most common complication was bleeding (57 %). Weight<5 kg (p = 0.01) and vasopressor use during support (p = 0.012) were associated with a risk for mortality. The survival rate at 10 years was 77 %; 84% of patients corresponded to functional class 1-2, and 37% had some degree of developmental delay.