ABSTRACT
In this retrospective study we report our initial experience with percutaneous venoarterial extracorporeal membrane oxygenation in the emergency treatment of intractable cardiogenic shock or pulseless electrical activity. Between January 1994 and July 1995, percutaneous venoarterial extracorporeal membrane oxygenation was attempted in seven patients (pulseless electrical activity, five patients; cardiogenic shock, two patients). In two of the seven patients, efforts at arterial cannulation resulted in cannula perforation at the level of the iliac artery. In the remaining five patients, percutaneous venoarterial extracorporeal membrane oxygenation could be established and was maintained for 3-84 h. Major bleeding remained a common complication during extracorporeal membrane oxygenation despite the use of heparin-coated bypass circuits and was responsible for death during extracorporeal membrane oxygenation in one patient. The remaining four patients could be weaned from mechanical circulatory support within 24 h, two after surgical interventions (resection of right atrial tumor, heart transplantation), one after thrombolytic therapy. In one patient, cardiac function recovered spontaneously after 6 h on venoarterial extracorporeal membrane oxygenation. Three patients were discharged from hospital, two of them made a full recovery, one sustained severe hypoxic brain injury. A few patients with intractable cardiogenic shock or pulseless electrical activity can be resuscitated with the help of emergency percutaneous venoarterial extracorporeal membrane oxygenation. Emergency venoarterial extracorporeal membrane oxygenation is associated with a high rate of complications and its use should therefore be limited to selected patients with a rapidly correctable underlying cardiopulmonary pathology (anatomic, metabolic or hypothermic) who do not respond to conventional advanced cardiac life support.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart Arrest/therapy , Shock, Cardiogenic/therapy , Emergencies , Extracorporeal Membrane Oxygenation/adverse effects , Female , Hemorrhage/etiology , Humans , Male , Middle Aged , Resuscitation/methods , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
38 patients (20 men, 18 women) underwent reoperation between July 1989 to September 1992 because of degeneration of bioprosthetic valves implanted in aortic or/and mitral position. Retrospective analysis revealed a mean implantation time of 116.5 +/- 31.5 months for the bioprostheses (median 116). At reoperation 63.2% of them had a single valve replacement, 36.8% a more complex cardiac procedure (double or triple valve replacement, valve replacement and coronary bypass grafting). 50% (n = 9) of the reoperation cohort were symptomatic (NYHA III), 16 (42.1%) were serious symptomatic (NYHA IV). All deaths were NYHA IV preoperatively. Early mortality was 18.4% (n = 7). Mean age at the time of first operation was 51 +/- 10.7, mean age at reoperation was 60.5 +/- 10.6. There was a significantly longer aortic clamp time (AKT, p = 0.0005) and bypass time (BPT, p = 0.0000) compared to first operation, also a significantly longer BPT of the deads confronted with the survivors (p = 0.0075). Bioprosthetic valves in mitral position were significantly longer implanted (p = 0.0416) than in aortic position. But there was no difference in implantation time of commercially available Carpentier-Edwards- or Ionescu-Shiley grafts. At reoperation we changed more than 95% of the degenerated valves to mechanical devices--corresponding to international tendencies. We discuss the early tissue degeneration of bioprosthetic valves and their increasing problem during reoperation.
