Erișkin Akut Kardiyojenik Șoklu Hastalarda Veno-Arteriyel Ekstra-korporeal Membran Oksijenasyon Desteği: Retrospektif Analiz

Year 2017, Volume: 70 Issue: 2, 111 - 117, 20.08.2017

A.rüçhan Akar

https://doi.org/10.1501/Tipfak_0000000974

Abstract

Amaç: Ekstrakorporeal Membran Oksijenatör Sistemi (ECMO), respiratuar, kardiyak veya kombine yetmezliği olan hastalarda, hayat kurtarıcı bir teknik olarak kullanılmaktadır. Bu çalıșmada, refrakter kardiyojenik șok (RKS) nedeniyle veno-arteriyel ekstrakorporeal membran oksijenasyon (VA-ECMO) desteği gereken hastaların sonuçlarını değerlendirmek amaçlanmıștır.

Gereç ve Yöntem: Kliniğimizde, “Mart 2010 - Kasım 2016” yılları arasında, RKS nedeniyle VA-ECMO desteğine alınan hastaların sonuçları retrospektif olarak analiz edildi. Toplam 189 hastaya RKS nedeniyle (127’i erkek, yaș ortalaması = 56.6 ± 12.0; BSA ortalaması=1,85 ± 0,19) VA-ECMO implantasyonu yapıldı. Tüm hastaların demografik ve klinik dataları incelendi.

Bulgular: Ortalama VA-ECMO desteği süresi, 172.8 ± 234.2 saat (4-1920 saat) olarak hesaplandı. VAECMO desteğinden ayrılabilme (n=92; 48.6 %), toplam survey (n=74, 39.2 %) ve ECMO desteği sırasında görülen vasküler (n=21, 11.1%) ve nörolojik (n=11, 5.8%) komplikasyon oranlarının literatür ile benzerlik gösterdiği tespit edildi.

Sonuç: ECMO desteğindeki hastalar çoğunlukla multi-sistemik komplikasyonlara bağlı kaybedilmektedir. ECMO sistemlerindeki ve tekniklerindeki gelișim ile birlikte, mevcut hasta populasyonundaki sağkalım oranları artmakta ve olușabilecek komplikasyon oranları azalmaktadır. Özellikle son on yılda, hibrid ECMO sistemlerinin ve adjuvan kateter aracılı girișimlerin kullanılması, VA-ECMO desteğindeki hastaların hızlı ve güvenli bir șekilde düzelmesine katkı sağlamaktadır. Ülkemizde, daha fazla merkezde, ECMO ile ilgili deneyimin artması, bu tedaviden faydalanan hasta sayısında belirgin artıș olmasını sağlayacaktır. 

Keywords

Ekstrakorporeal Membran Oksijenatörü, Refrakter Kardiyojenik Ș ok, Respiratuar Yetmezlik, Kalp Yetmezliği

References

• 1. Rihal CS, Naidu SS, Givertz MM, et al. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention. J Am Coll Cardiol 2015;65:e7-e26.
• 2. Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 2009;119:12111219.
• 3. Truby L, Mundy L, Kalesan B, et al. Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center. ASAIO J 2015;61:403-409.
• 4. Zangrillo A, Landoni G, Biondi-Zoccai G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc 2013;15:172-178.
• 5. Paden ML, Conrad SA, Rycus PT, et al. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J 2013;59:202-210.
• 6. Hill JD, O'Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 1972;286:629-634.
• 7. Fiser S, Tribble CG, Kaza AK, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg 2001;71:210–214.
• 8. Wu MY, Lin PH, Lee MY, et al. Using extracorporeal life support to resuscitate adult postcardiotomy cardiogenic shock: Treatment strategies and predictors of short-term and midterm survival. Resuscitation. 2010;81:1111-1116.
• 9. Rastan AJ, Dege A, Mohr M, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302-311.
• 10. Park SJ, Kim SP, Kim JB, et al. Blood lactate level during extracorporeal life support as a surrogate marker for survival. J Thorac Cardiovasc Surg. 2014;148:714720.
• 11. Marasco SF, Lukas G, McDonald M, et al. Review of ECMO (Extra Corporeal Membrane Oxygenation) Support in Critically Ill Adult Patients. Heart, Lung and Circulation 2008;17:41–47.
• 12. Narotsky DL, Mosca MS, Greenberger HM, et al. Short-term and longer-term survival after veno-arterial extracorporeal membrane oxygenation in an adult patient population: does older age matter?. Perfusion 2016; 31(5): 366–375.
• 13. Moravec R, Neitzel T, Stiller M, et al. First experiences with a combined usage of veno-arterial and veno-venous ECMO in therapy-refractory cardiogenic shock patients with cerebral hypoxemia. Perfusion 2014; 29(3): 200–209.
• 14. Avgerinos DV, DeBois W, Voevidko L, et al. Regional Variation in Arterial Saturation and Oxygen Delivery during Venoarterial Extracorporeal Membrane Oxygenation. JECT. 2013;45:183–186
• 15. Rupprecht L, Flörchinger B, Schopka S, et al. Cardiac Decompression on Extracorporeal Life Support: A Review and Discussion of the Literature. ASAIO Journal 2013; 59:547–553
• 16. Foley PJ, Morris RJ, Woo EY, et al. Limb ischemia during femoral cannulation for cardiopulmonary support. J Vasc Surg. 2010;52:850-853.
• 17. Bisdas T, Beutel G, Warnecke G, et al. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg. 2011;92:626631.
• 18. Greasıb JK, Hemp JR, Maxwell JM, et al. Prevention of distal limb ischemia during cardiopulmonary support via femoral cannulation. Annals Thorac Surg 1995;60:209-210.
• 19. Benassi F, Vezzani A, Vignali L, Gherli T. Ultrasound Guided Femoral Cannulation and Percutaneous Perfusion of the Distal Limb for VA ECMO. J Card Surg. 2014;29:427-429.
• 20. Hilty WM, Hudson PA, Levitt MA, et al. Real time US guided femoral vein catheterization during cardiopulmonary resuscitation. Ann Emerg Med 1997;29:331-337.
• 21. Chamogeorgakis T, Lima B, Shafii AE, et al. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2013 Apr;145(4):1088-1092.
• 22. Müller T, Bein T, Philipp A, et al. Extracorporeal pulmonary support in severe pulmonary failure in adults: a treatment rediscovered. Dtsch Arztebl Int. 2013 March; 110(10):159-166.
• 23. Sidebotham D, McGeorge A, McGuinness S, et al. Extracorporeal membrane oxygenation for treating severe cardiac and respiratory failure in adults: part 2technical considerations. J Cardiothorac Vasc Anesth. 2010 Feb;24:164-172.
• 24. Conrad SA, Rycus PT, Dalton H. Extracorporeal Life Support Registry Report 2004. ASAIO J. 2005;51:4-10.
• 25. Muehrcke DD, McCarthy PM, Stewart RW, et al. Complications of extracorporeal life support systems using Heparin-Bound Surfaces: The risk of intracardiac clot formation. The Journal of Thoracic and Cardiovascular Surgery 1995;110:843–851.
• 26. Smedira NG, Moazami N, Golding CM, et al. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: Survival at five years. The Journal of Thoracic and Cardiovascular Surgery 2001;122:92-102.
• 27. Schmidt M, Brechot N, Hariri S, et al. Nasocomial Infections in Adult Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation. Clinical Infectious Diseases 2012;55:16331641.
• 28. Cavarocchi NC, Pitcher HT, Yang Q, et al. Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography. J Thorac Cardiovasc Surg. 2013;146:14741479.