OP-189 ECMO WITH BIVALURIDIN IN EXTUBATED PATIENT: THE “HOLY GRAIL” OF ECMO OR ONLY A FASHIONABLE POLICY?

Abstract

fast-track may be used to reduce VAP in this setting. Methods: In a tertiary care center for Heart Transplantation and Cardiovascular Surgery during the last two years of experience 9 patients were implanted with an ECMO (central 8 cases and peripheral cannulation 1 case) and treated with bivaluridin aiming to reduce coagulative disorders. All patients were kept extubate immediately after implantation. The indication for ECMO implantation was Early Graft Failure (EGF) in 2 cases, post-cardiotomy failure in 2 cases, Acute Rejection in 1 case, acute complications of myocardial infarction in 4 cases. Results: ECMO was successful in warrant optimal perfusion in all cases. HIT nor pneumonia were never observed in this small series. Two cases of pulmonary edema were managed with noninvasive CPAP ventilation with helmet. One ECMO (postcardiotomy) was futile due to Cerebral Anoxia. One patient underwent successful heart transplantation and 2 patient underwent Interventricular Septum Closure. Weaning was performed according to the criteria of Aissaoui et al. (Patients who tolerated a full ECMO weaning trial and had aortic VTI C10 cm, LVEF(20-25%, and TDSa C6 cm/s at minimal ECMO flow). Hospital mortality however was 45%. In 2 cases (50%) mortality was due to poor residual myocardial function. Conclusions: A novel approach in the management of ECMO based on bivaluridin and fast extubation reduce the incidence of coagulative and infectious complications, although hospital mortality remain still high due to the poor preoperative conditions. Today the bridge to recovery is the principal aim of ECMO implantation at our istitution and the results strictly depend from the underlying disease. A careful echocardiographic evaluation (and probably also Fine Needle byopsies of the heart) and more effective algorithms to achieve a stable weaning from ECMO are necessary to reduce hospital mortality.