Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience

Perfusion. 2018 May;33(1_suppl):57-64. doi: 10.1177/0267659118766833.

Abstract

Introduction: The role of extracorporeal support for patients with septic shock remains unclear.

Methods: We conducted a retrospective analysis of our single-centre experience with veno-arterio-venous extracorporeal membrane oxygenation (VAV ECMO) in adult patients with severe respiratory failure and septic cardiomyopathy. Clinical data was extracted from electronic medical records including a dedicated ECMO referral and follow-up database.

Results: Twelve patients were commenced on VAV ECMO for septic cardiomyopathy for a median of four days (IQR 3.0 to 5.3) between 01/2014 and 12/2017. Five patients (41.7%) had a cardiac arrest prior to initiation of ECMO support. At baseline, median left ventricular ejection fraction was 16.25% (IQR 13.13 to 17.5) and median PaO2/FiO2 ratio was 9 kPa (IQR 6.5 to 12.0) [67.50 mmHg (IQR 48.75 to 90.00)]. The survival rate to hospital discharge for VAV ECMO was 75% in this cohort. None of the surviving patients died within the follow-up period (median six month).

Conclusion: VAV ECMO is a feasible rescue strategy for a small proportion of patients with combined respiratory and cardiac failure secondary to septic shock with septic cardiomyopathy. We provide a detailed report of our experience with this technique. Further research is required comparing the different extracorporeal strategies directly to conventional resuscitation and against each other.

Keywords: Acute heart failure; Extracorporeal life support; Extracorporeal membrane oxygenation (ECMO); Septic cardiomyopathy; Septic shock; Severe respiratory failure; Veno-arterio-venous extracorporeal membrane oxygenation (VAV ECMO).

MeSH terms

  • Adult
  • Cardiomyopathies / pathology
  • Cardiomyopathies / therapy*
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult