Authors (including presenting author) :
Fong KM (1), Au SY (1), Luk SF (1), Cheung YCV (1), Leung PWR (1), Ng WYG (1)
Affiliation :
(1) Intensive Care Unit, Queen Elizabeth Hospital
Introduction :
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of mechanical circulatory support for patients with profound cardiogenic shock. Peripheral VA ECMO works by drawing blood from the femoral vein and pumping back to the femoral artery via large bore catheters. As the patient’s cardiac function recovers, the ECMO is taken off by decannulation. Conventionally, the arterial wound needs open repair in the operation theater. However, delay in decannulation is not uncommon.
Objectives :
To evaluate the existing practice of VA ECMO decannulation and to explore the reasons and consequences of the delay in decannulation
Methodology :
We retrospectively reviewed all adult patients on VA ECMO in Intensive Care Unit, Queen Elizabeth Hospital, from May 2013 to Sept 2018. Exclusion criteria were central ECMO, pediatric patients, and those who were not decannulated because they died or transferred to other hospitals with ECMO.
Result & Outcome :
Results and Outcomes Among the 90 patients on VA ECMO, 57 patients survived. After screening, 40 survivors were included in the analysis. Eleven patients had ECMO initiated as part of extracorporeal cardiopulmonary resuscitation and the rest were for cardiogenic shock. We identified a delay of 24.0 [20.3 - 28.8] hours from the time the patients were declared fit for actual decannulation. In all 40 cases, the delay was related, to a certain extent, to the availability of operation theatres. Another factor was doctors’ availability: 19 were related to surgeons’ availability and 16 related to ICU doctors’ availability. Twelve patients were delayed as they fell on weekends or holidays. Four patients suffered persistent wound oozing requiring blood product transfusion while 2 patients had significant circuit clot with drop in ECMO flow during the delay. The median operation time was 3.0 hours [2.7-3.0]. Five patients required additional vascular procedures during vascular repair, which included thrombectomy and endartectomy. Conclusion
The delay in decannulation was multifactorial. Such delay not only demanded manpower and resources that could be unnecessary, but also put patient at risk of complications that should have been avoidable. Most patients did not require additional vascular procedures in the operating theatre. While percutaneous vascular closure has been increasingly used in vascular surgery and cardiac interventions, the result of this review would support the introduction of bedside percutaneous decannulation in patients with VA ECMO.
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