[EXTRACORPOREAL MEMBRANE OXYGENATION IN ISRAEL: 6.5 YEARS OF EXPERIENCE AT THE LARGEST ECMO TREATMENT CENTER IN ISRAEL].

AIMS: The primary purpose of the study is to evaluate the characteristics of the population treated with ECMO at Beilinson Hospital, the treatment results and a comparison of results with ECMO centers in the world. The treatment outcomes relative to the experience of the team during the years 2008-2014 were also examined. The secondary purpose of this article is to increase the awareness of the medical staff to ECMO as a treatment option for patients with appropriate indications, where indications have increased in recent years. BACKGROUND: In recent years, there has been a significant increase in extracorporeal life support as a substitute for cardiac function (VA-ECMO) and lung function (VV-ECMO) in light of technological improvements and the experience of the medical teams. The most significant increase in the use of ECMO as a replacement lung function began after the publication of the CESAR study in 2009, which demonstrated a decrease in mortality of patients with acute respiratory distress syndrome treated with ECMO, compared with conservative treatment. Furthermore, during the H1N1 epidemic in 2009-10, a number of observational studies reported good results with the use of ECMO in patients with severe respiratory insufficiency. METHODS: A retrospective gathering of information, during the period August 2008 to December 2014. Results: During this time, a total of 171 patients were connected to ECMO, 128 patients were connected to AV-ECMO and 43 patients were connected to VV-ECMO. The main causes of respiratory failure were pneumonia (mostly viral) and ARDS; 60% of patients with respiratory failure were successfully weaned from ECMO, and 51% in total were released from intensive care; 71% of patients treated with VA-ECMO were successfully weaned, and 58% in total were released from intensive care. During the six years in which the survey was conducted there was an improvement in patient survival. In 2009 only a third of the patients were released from intensive care, while in 2014 over 71% were discharged. DISCUSSION: This study reports for the first time on the morbidity characteristics, type of ECMO used and the results of all patients receiving treatment with ECMO in an intensive care unit at a tertiary hospital in Israel. The number of cases treated with ECMO is on the rise in recent years, both globally and in Israel, with good results. Therefore, this treatment option for patients with severe respiratory and/or cardiac insufficiency should be considered as a therapeutic option in appropriate situations.

The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting.

OBJECTIVE: Our objective was to assess the effect of the timing of cardiac angiography, contrast media dose, and preoperative renal function on the prevalence of acute renal failure after cardiac surgery. METHODS: Data on 395 consecutive patients who underwent coronary artery bypass grafting were prospectively collected. Creatinine clearance was estimated by the Cockcroft-Gault equation. Patients were divided into 3 groups according to the time between cardiac angiography and surgery (group A, < or = 1 day; group B, > 1 day and < or = 5 days; group C, > 5 days). Patients who underwent a salvage operation or were receiving dialysis before surgery were excluded. Acute renal failure was defined as 25% decrease from baseline of estimated creatinine clearance and estimated creatinine clearance of 60 mL/min or less on postoperative day 3. Owing to differences in preoperative characteristics between groups, propensity score analysis was used to adjust those differences. RESULTS: Acute renal failure developed in 13.6% of patients. Hospital mortality was 3.3% and was higher in patients in whom acute renal failure developed (22%) versus those in whom it did not (0.3%; P < .001). Multivariable analysis identified preoperative estimated creatinine clearance of 60 mL/min or less (odds ratio [OR], 7.1), operation within 24 hours of catheterization (OR = 3.7), use of more than 1.4 mL/kg of contrast media (OR = 3.4), lower hemoglobin level (OR = 1.3), older age (OR = 1.1), and lower weight (OR = 0.95) as independent predictors of postoperative acute renal failure. Analysis of interaction between contrast dose and time of surgery revealed that high contrast dose (>1.4 mL/kg) predicted acute renal failure if surgery was performed up to 5 days after angiography. CONCLUSIONS: Whenever possible, coronary bypass grafting should be delayed for at least 5 days in patients who received a high contrast dose, especially if they also have preoperative reduced renal function.