Abstract
Abstract Extracorporeal life support is a rescue therapy when mechanical ventilation is unable to maintain adequate tissue oxygenation in the setting of acute cardiac or respiratory failure. Outcome is influenced not only by factors independent of ECMO but also by the potential complications related to ECMO. The study is designed to understand the outcomes of Extracorporeal membrane oxygenation in the management of Acute Cardio Respiratory failure in adult population. The study is analytical and the data is prospectively collected from a local registry of ECMO patients and ICU clinical database. Further, clinical details were obtained from prospective review of patient medical records. The study period is from November 2013 and November 2015. A total of 30 patients were included in the study 36.7% were weaned off ECLS and 33.3% survived to hospital discharge. Incidence of Heparin Induced Thrombocytopenia was observed in 3 patients. 27 patients went into renal dysfunction. Both ICU duration (p-0.945) and duration of ECMO (0.736) support did not prove to be significant in predicting mortality. No cannula related vascular complications leading to limb ischemia or need for vascular repair were encountered in any patient. Mean number of blood transfusions required during ECMO support were 15.17 units. Infections acquired on ECMO support, p=0.052; 95% CI=0.007-1.707. Our results endorse the use of ECMO as a rescue therapy in adults, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. However, ECMO is still marred by frequent and significant complications such as renal derangement, bleeding and nosocomial infections.
Highlights
Extracorporeal membrane oxygenation (ECMO) is a rescue therapy to support severe respiratory and /or cardiac failure
Our results endorse the use of ECMO as a rescue therapy in adults, there are some risks associated with a learning curve as well as an important increase in the days of patient stay
All these patients received CRRT during ECMO support and renal parameters returned to baseline values in patients who survived
Summary
Extracorporeal membrane oxygenation (ECMO) is a rescue therapy to support severe respiratory and /or cardiac failure. ECMO complications may be mechanical (relating to the ECMO circuit components) or medical [14] The latter are the most frequent and include bleeding, infection, embolism causing vascular and neurological complications and limb ischemia. Neurologic complications are probably underestimated and can have devastating consequences on the prognosis [3,23] Vascular complications such as amputation may be delayed and perhaps under-reported. Bloodstream infections during ECMO have been associated with a poor outcome in paediatric patients [19,24] but the association remains uncertain in adults [17,21,25] Bleeding is another frequent adverse event in these patients who are critical ill, exposed to anticoagulation and susceptible to coagulopathy and platelet dysfunction. Mechanical complications and haemolysis have decreased with the introduction of centrifugal pumps, low-resistance polymethyl-pentene membranes and modern heparin-coated surfaces
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