The Clinical Application Of Venous-arterial Extracorporeal Membrane Oxygenation In The Perioperative Period Of Cardiovascular Surgery

Objective:To summarize the clinical application experience of Venous-arterial Extracor-poreal Membrane Oxygenation(VA-ECMO)in cardiovascular surgery,and investi-gate the factors influencing the prognosis of VA-ECMO.Method:To collect the clinical data of 67 patients who received VA-ECMO adjuvant treatment for perioperative heart failure in the department of cardiovascular surgery of the Second Hospital of Jilin University from August 1st 2013 to July 31st 2017.The Extracorporeal Membrane Oxygenation(ECMO)support time,mechanical ventilation time,survival rate,survival rate and complications were counted to explore the factors influencing the prognosis of ECMO.Result:Among the 67 patients,41 were male and 26 were female,whose ages ranged from 22 months to 78 years.There were 3 cases of children aged 22,24 and 30 months and 64 adult patients,aged from 32 to 78 years,with an average age of(56.52±10.99)years.The support time of ECMO ranged from 9 to 602h,and the average ECMO support time was(235.79±123.87)hours.The mechanical ventilation time ranged from 3 to 871 hours,and the averagemean mechanical ventilation time was(166.11±148.31)hours.Among the 67 patients,49 patients(73.13%)weaned off successfully from ECMO,38 patients(56.72%)had been discharged from hospital,and 18 had given up treatment.Among the 67 patients,21 had valvular disease,14 had ECMO weaned off(66.67%),and 11 had discharge(52.38%).There were 15 cases of coronary heart disease,11 cases of ECMO weaned off(73.33%),and 8 cases of discharge(53.33%).There were 11 cases of coronary heart disease with valvular disease,6 cases of ECMO weaned off(54.55%),and 4 cases of discharge(36.36%).There were 6 cases of congenital heart disease,all ECMO were weaned off(100%),5 cases were discharged(83.33%).There were 13 cases of aortic dissection,11 cases of ECMO weaned off(84.62%),and 9 cases of discharge(69.23%).One case of preoperative acute myocardial infarction was successfully survived weaned off.Complications occurred in 29 of the 67 patients,with mediastinal hemorrhage secondary thoracotomy hemostatic 6 cases(8.96%),bleeding intubation,3 cases(4.48%),4 cases of gastrointestinal bleeding(5.97%),intracranial hemorrhage in 1 case(1.49%),lower limb venous thrombosis in 2 cases(2.99%),postoperative infection,9 cases(13.43%),acute kidney injury(AKI)paralleled continuous renal replacement therapy(CRRT)of 14 cases(20.9%),acromegaly peripheral ischemia in 3 patients(4.48%),and8 cases(11.94%)were treated with Intra-aortic Balloon Counterpulsation(IABP)at the same time.Conclusion:VA-ECMO is an efficient support for perioperative critically severe patients undergoing cardiovascular surgery.Patients with aortic dissection combined with coronary artery disease should be treated with ECMO as soon as possible once low cardiac output syndrome(LCOS)occurs.The key to successful treatment of VA-ECMO is to grasp the indications and timing of ECMO,stop mechanical ventilation as soon as possible,actively prevent and control bleeding,rational anticoagulation,control infection,protect organ function and prevent extremity ischemia.