Therapy strategy of extracorporeal membrane oxygenation (ECMO) combine with intra aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) and respiratory machine in serious condition cardiac surgery cases

Abstract

Objective To investigate clinic results of the extracorporeal membrane oxygenation (ECMO) technique combine with Intro aortic balloon pump (IABP),Continuous renal replacement therapy (CRRT),respiratory machine therapy in the serious condition cardiac surgery cases.Methods From 2004 to 2009 all data of the cases received the ECMO therapy were analyzed retrospectively.Results Totally 180 cases were treated with extracorporeal membrane oxygenation (ECMO) technique in this period of time with weaning rate of 68.9％ and survival rate of 72.8％.Besides of the of replacing rountine CPB 69 cases,49 cases died in the 111 cases of routine used ECMO cases (survival rate 55.9％).There were 40 cases treated with ECMO combined with IABP in which 23 cases died (survival rate 42.5％).After the first use of IABP 28 cases were treated with ECMO because of hemodynamic instability and 9 died (survival rate 54％).After the first use of ECMO because of severe valve disease or hemodynamic instability after heart transplantation,or emergency cardiopulmonary resuscitation and the IABP was admitted in 12 cases for the small pulse pressure,decreased left ventricular contraction (10 died,survival rate 36.1％).48 cases were treated with ECMO combined with CRRT (total survival rate 40％).In these cases 6 cases were treated with CRRT first and 4 cases died (survival rate 33.3％).And 42 cases received the ECMO first and 25 cases died (survival rate 47.9％).In the total series 19 cases were treated with ECMO combined with IABP,CRRT,respiratory machine and 12 cases died (survival rate 36.1％).Conclusion ECMO is an effective technique for the heart failure after cardiac surgery,the earlier use may bring earlier recovery of the heart function.Combine administration of ECMO,CRRT,IABP and respiratory machine may be adopted for the multiple organs failure cases with attention of the coordinate and weaning orders among the machines. Key words: Cardiac surgical procedures; Extracorporeal membrane oxygenation (ECMO) ; Intro aortic balloon pump(IABP); Continuous renal replacement therapy(CRRT) ; Respiratory machine