Initial experience with CentriMag extracorporal membrane oxygenation for support of critically ill patients with refractory cardiogenic shock.

BACKGROUND: Cardiogenic shock refractory to conventional therapy has very high mortality and limited support options. New technology with peripherally inserted CentriMag (Levitronix LLC, Waltham, MA) extracorporal membrane oxygenation (ECMO) may have the potential to significantly improve survival in these critically ill patients. Outcomes of the first 10 patients to receive this device at our institutions are presented. METHODS: Patients were identified by their primary physicians and evaluated by our Mechanical Circulatory Support Team. CentriMag ECMO was initiated at the bedside using sterile percutaneous cannulation of femoral vessels. Patients were admitted to the Heart and Vascular Intensive Care Unit, with care managed by regular nursing staff with special training. RESULTS: The patients (5 men, 5 women) were a mean age of 45 +/- 18 years, had a mean left ventricular ejection fraction of 30%, and a mean lactate level of 9 mmol/liter. All patients met criteria for shock refractory to medical therapy, but the etiology varied. Average duration of ECMO support was 5.8 +/- 4 days. Survival was 60%. There were no major complications directly related to the device and no equipment malfunctions. CONCLUSIONS: The peripherally inserted CentriMag ECMO was easy to insert, functioned without mechanical error, and significantly reduced expected mortality in critically ill patients. Further research will be necessary to develop standardized algorithms and gain more experience, but this new technology has promising potential.

Evidence-based practice strategies for cardiovascular care.

Evidence-based practice (EBP) is a problem-solving approach utilizing the best available information to support clinical decisions. The cardiovascular literature sufficiently supports the adoption of EBP to reduce practice variations and improve patient outcomes. However, the ability to appraise evidence and determine the best ways to implement evidence into practice remains a challenge for most clinicians and administrators. Our discussion assesses the quality of evidence and the benefits of evidence-based approaches to care, but also frames the distinctions among research-based, evidence-based, and best practice. Organizational infrastructure is key to developing EBP approaches and sustaining high quality of care.