Sabashnikov, Anton ORCID: 0000-0002-6289-1035, Djordjevic, Ilja, Deppe, Antje-Christin, Kuhn, Elmar W., Merkle, Julia, Weber, Carolyn, Sindhu, Dirk, Eghbalzadeh, Kaveh, Zeriouh, Mohamed, Liakopoulos, Oliver J., Rahmanian, Parwis B. ORCID: 0000-0002-3978-9251, Kuhn-Regnier, Ferdinand, Choi, Yeong-Hoon, Madershahian, Navid and Wahlers, Thorsten (2018). Managing Traps and Pitfalls During Initial Steps of an ECMO Retrieval Program Using a Miniaturized Portable System: What Have We Learned From the First Two Years? Artif. Organs, 42 (5). S. 484 - 493. HOBOKEN: WILEY. ISSN 1525-1594

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Abstract

The aim of this study was to provide early and mid-term results of the newly established extracorporeal membrane oxygenation (ECMO) retrieval service in a tertiary cardiothoracic center using the miniaturized portable Cardiohelp System (Maquet, Rastatt, Germany). A particular attention was paid to organizational and logistic specifics as well as challenges and pitfalls associated with initial phase of the program. From January 2015 until January 2017 a heterogenic group of 28 consecutive patients underwent ECMO implantation in distant hospitals for acute cardiac, pulmonary or combined failure as a bridge-to-decision and were subsequently transported to our institution. Each cannulation was performed bedside on intensive care units (ICU) using the Seldinger's technique. Early outcomes and mid-term overall survival with up to two-year follow-up along with the impact of ongoing cardiopulmonary resuscitation (CPR) on outcome were presented. Also, changes in hemodynamics and tissue perfusion factors 24 h after ECMO implantation were evaluated. ECMO implantations were performed in 15 distant departments with the median distance of 23(10;40) (maximum 60) km. A total of 15 patients (54%) were cannulated under CPR with the median duration of 30(20;110) (maximum 180) min. After 24 h of support there were significant improvements in SvO(2) (P=0.021), mean arterial pressure (P=0.027), FiO(2) (P=0.001), lactate (P=0.001), and pH (P<0.001). The mean ECMO support duration was 96 +/- 100 (maximum 384) hours, whereas 11 patients (40%) were weaned off support and discharged from hospital. Overall cumulative survival in patients without the need for CPR was 61.5% at one week and 38.5% at 1 month, 6 month, and 1 year, whereas patients requiring CPR survived in 40% at one week, and 33.3% at 1 month, 6 month, and 1 year (Log-Rank (Mantel-Cox) P=0.374, Breslow (Generalized Wilcoxon) P=0.162). Our initial experience shows that launching new ECMO retrieval programs in centers with sufficient ICU capacities and local ECMO experience can be feasible and associated with acceptable real world results despite the initial learning curve. Rapid logistical organization and team flexibility are the key points to ensure comparable survival of patients requiring prolonged CPR.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Sabashnikov, AntonUNSPECIFIEDorcid.org/0000-0002-6289-1035UNSPECIFIED
Djordjevic, IljaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Deppe, Antje-ChristinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuhn, Elmar W.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Merkle, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber, CarolynUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sindhu, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Eghbalzadeh, KavehUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zeriouh, MohamedUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liakopoulos, Oliver J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rahmanian, Parwis B.UNSPECIFIEDorcid.org/0000-0002-3978-9251UNSPECIFIED
Kuhn-Regnier, FerdinandUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Choi, Yeong-HoonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Madershahian, NavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wahlers, ThorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-186779
DOI: 10.1111/aor.13067
Journal or Publication Title: Artif. Organs
Volume: 42
Number: 5
Page Range: S. 484 - 493
Date: 2018
Publisher: WILEY
Place of Publication: HOBOKEN
ISSN: 1525-1594
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
EXTRACORPOREAL MEMBRANE-OXYGENATION; HOSPITAL CARDIAC-ARREST; CARDIOPULMONARY-RESUSCITATION; LIFE-SUPPORT; 5-YEAR EXPERIENCE; ORGANIZATION; MORTALITY; SURVIVAL; RESCUE; BRIDGEMultiple languages
Engineering, Biomedical; TransplantationMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/18677

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