The Role of Extracorporeal Membrane Oxygenation in The Protective Lung Strategy after Cardiac Surgery in a Tertiary Intensive Care Unit

Ibrahim Mungan, ,Sema Turan

doi:10.53986/ibjm.2020.0013

Abstract

Background: In cases of respiratory failure, Lung-Protective Ventilation Strategy (LPVS) which limits ventilator-induced lung injury is recommended. However, CO2 retention is a major impediment for LPVS and Extracorporeal membrane oxygenation (ECMO) supplies enough time to the lungs for rest and recovery. We aimed to find out the connection between ECMO usage and the reduction of mechanical ventilatory values in patients who required ECMO therapy after cardiac surgery due to pulmonary failure. Methods: In this retrospective cohort study, we analyzed 21 consecutive patients receiving a venovenous ECMO for pulmonary failure after cardiac surgery and 19 patients non-ECMO group. Demographic variables including age, gender, predicted body weight, and heart rate and the arterial blood gas analysis data, mechanical ventilator parameters and clinical outcomes were derived from institutional database. Results: The mean age of the patients was 55.57 years and ECMO patients were younger than non-ECMO group patients (p=0.005). The other descriptive variables and clinical parameters did not differ between groups statistically. The mechanical ventilator parameters and arterial blood gas analysis were worse in the ECMO group before the procedure (p <0.001) whereas improvement in data was more significant in the ECMO group after the procedure (p<0.001 in Pplateau and PaO2) . The patients in the non-ECMO group stayed longer in hospital (35.68 days vs 16.9 days) and in ICU (31.11 days vs 13.33 days) than the patients in the ECMO group. The duration of the mechanical ventilatory support did not differ between groups. Conclusion: The intensivists had a big dilemma involving the balance between maintaining a sensible blood-gas exchange and protecting the lung from adverse effects of mechanical ventilatory support. The extracorporeal life support –ECMO- was advised until the pulmonary failure was resolved. We found that ECMO support was decreasing the high Plateau Pressure and respiratory rate more than the non-ECMO group.

Highlights

Introduce the paper, and put a nomenclature if necessary, in a box with the same font size as the rest of the paper
Ventilation Strategy (LPVS) which suggests the usage of low tidal volume, depending on ideal body weight (IBW), and adequate levels of Positive End Expiratory Pressure (PEEP) with low threshold levels of Plateau Pressure (Pplateau), is recommended
The 2019 international report of the Extracorporeal Life Support Organization (ELSO) Registry showed that 59% of the adult patients receiving Extracorporeal membrane oxygenation (ECMO) for severe pulmonary failure and 43% of the adult patients receiving ECMO for cardiac failure can be discharged from hospital and these ratios were getting better every year [7]

Summary

Introduction

Put a nomenclature if necessary, in a box with the same font size as the rest of the paper. Cardiac surgery may be complicated by severe myocardial dysfunction and mild or moderate pulmonary dysfunction as in the case of ARDS or low cardiac output syndrome [8] In these conditions, extracorporeal life support systems like ECMO might be required. The limits of MV like tidal volume per ideal body weight (VT-IBW) and Pplateau could be reduced by ECMO in accordance with lung-protective ventilation strategy. This reduction extenuates the intensity and danger of VILI in theoretical [3]. We aimed to find out the connection between ECMO usage and the reduction of mechanical ventilatory values in patients who required ECMO therapy after cardiac surgery due to ARDS or pulmonary failure. We found that ECMO support was decreasing the high Plateau Pressure and respiratory rate more than the non-ECMO group

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