| Objective To assess the effectiveness of extracorporeal membrane oxygenation (ECMO) in critically ill patients for adult cardiac surgery department,and find out the early predictors on survival of ECMO patients and the correlation between ECMO related complication and patients' prognosis as well as investigating biocompatibility of the heparin-coated circuits,so as to provide further guidance for future clinical application of ECMO.Methods The history of the 13 patients supported by ECMO due to failing to be weaned off cardiopulmonary bypass in intraoperative periods or the occurrence of low cardiac output syndrome in perioperative time were collected,from November 2006 to December 2008 in cardiac surgery department,Zhongshan hospital affiliated to Fudan university.Then the survival rate of patients discharged from hospital were analyzed,so were the preoperative and operative status as well as postoperative complication divided by survival group and death group.Besides,ECMO biocompatibility was assessed with a scanning electron microscopy in heparin-coated surface of ECMO in 2 patientsResults Among the 13 patients,9 patients were successfully weaned off ECMO(69.23%),and 4 patients survived to hospital discharge,so its overall survival rate was 30.76%.There were no statistical differences in preoperative information such as gender,age,height,body weight,left ventricular eject fraction,blood cell count,hepatic function and renal function between survival group and death group. The mean time of cardiopulmonary bypass was 130±103 min for survivors vs 211.5±147 min for non-survivors(p=0.3141) and the mean aortic clamping time was 130±103 min in survivors vs 211.5±147 min in non-survivors(p =0.4407).The mean duration of ECMO was respectively 152.5±13 h vs 62.7±26.8 h(p =0.0001).The mean duration of mechanical ventilation was respectively 20.5±13 days in survivors vs 11.1±11.5 days in non-survivors(p=0.2391 ).The postoperative daily hepatic function and renal function in death group were significantly worse than those of survival group(p＜0.05).No significant difference was found in postoperative daily pericardial and mediastinal drainage and infusion of blood products between two groups were similar(p＞0.05).The mean number of organ systems with failure was significantly different between the two groups(survivors,3.25;nonsurvivors,5.33;p =0.0025).There was no survivor when the number of organ systems with failure was equivalent to or more than 5 or when positive blood culture were detected.The oxygenator was replaced in 4 patients on account of plasma leakage.The incidence of massive hemorrhage in pericardium and mediastinum and ooze in profuse amounts at the site of peripheral insertion were respectively 41.65%and 30.76%.The scanning electron microscopy in heparin-coated surface of ECMO showed a large number of red blood cells adhering to and fiber cord depositing on the wires and the surface of membrane when the duration of ECMO exceeded 4 days.Conclusion ECMO is a very useful treatment modality for these patients who failed to respond to other traditional treatment modality although it has a high mortality in application in adult cardiac surgery department.However,there are no obvious early predictors on survival of ECMO patients in the present study.There is an direct association between severity of preoperative diseases and the prognosis of patients,so ECMO should be employed at early time in severe patients with heart failure with a view to the likelihood of organ recovery.The prognosis of patients with postoperative renal failure,hepatic failure,positive blood culture or MSOF are poorer. In particular,in patients with the number of organ systems with failure were equivalent to or more than 5,the result is much poorer,so they can serve as the predictors of the prognosis.Hemorrhage is the most common complication which is still a problem unresolved nowadays.Heparin-coated surface can obviously improve the biocompatibility of ECMO,but there are some limitations in long-term support,so the equipment of ECMO should be further developed. |
