Veno-Arterial Extracorporeal Membrane Oxygenation in the Adult: A Bridge to the State of the Art

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Abstract

Despite the technological advancements in the last 40 years, conditions such as refractory cardiogenic shock and cardiac arrest still present a very high mortality rate in real-world clinical practice.

In this light, we have reviewed the techniques, indications, contraindications, and results of the so- called Veno-Arterial Extracorporeal Circulatory Membrane Oxygenation (VA-ECMO) in the adult population to evaluate the current results of this temporary cardio-pulmonary support as salvage and/or bridge therapy in the patient suffering from refractory cardiogenic shock or cardio-circulatory arrest.

The results are encouraging, especially in the setting of refractory cardiogenic shock and in-hospital cardiac arrest. Among a selected population, the prompt institution of a VA-ECMO may radically change the prognosis by sustaining vital functions while looking for the leading cause or waiting for the reversal of the temporary cardio-respiratory negative condition.

The future directions aim to standardized and shared protocols, miniaturization of the machines, and possibly the institution of specialized “ECMO teams” for in and the out-of-hospital institution of the tool.

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To construct a scoring system for the prediction of early mortality in cardiac surgical patients in Europe on the basis of objective risk factors. The EuroSCORE database was divided into developmental and validation subsets. In the former, risk factors deemed to be objective, credible, obtainable and difficult to falsify were weighted on the basis of regression analysis. An additive score of predicted mortality was constructed. Its calibration and discrimination characteristics were assessed in the validation dataset. Thresholds were defined to distinguish low, moderate and high risk groups. The developmental dataset had 13,302 patients, calibration by Hosmer Lemeshow Chi square was (8) = 8.26 (P 200 micromol/l (2), active endocarditis (3) and critical preoperative state (3). Cardiac factors were unstable angina on intravenous nitrates (2), reduced left ventricular ejection fraction (30-50%: 1, 60 mmHg (2). Operation-related factors were emergency (2), other than isolated coronary surgery (2), thoracic aorta surgery (3) and surgery for postinfarct septal rupture (4). The scoring system was then applied to three risk groups. The low risk group (EuroSCORE 1-2) had 4529 patients with 36 deaths (0.8%), 95% confidence limits for observed mortality (0.56-1.10) and for expected mortality (1.27-1.29). The medium risk group (EuroSCORE 3-5) had 5977 patients with 182 deaths (3%), observed mortality (2.62-3.51), predicted (2.90-2.94). The high risk group (EuroSCORE 6 plus) had 4293 patients with 480 deaths (11.2%) observed mortality (10.25-12.16), predicted (10.93-11.54). Overall, there were 698 deaths in 14,799 patients (4.7%), observed mortality (4.37-5.06), predicted (4.72-4.95). EuroSCORE is a simple, objective and up-to-date system for assessing heart surgery, soundly based on one of the largest, most complete and accurate databases in European cardiac surgical history. We recommend its widespread use.

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Author and article information

Journal

Journal ID (nlm-ta): Curr Cardiol Rev

Journal ID (iso-abbrev): Curr Cardiol Rev

Journal ID (publisher-id): CCR

Title: Current Cardiology Reviews

Publisher: Bentham Science Publishers

ISSN (Print): 1573-403X

ISSN (Electronic): 1875-6557

Publication date (Print): 20 July 2021

Publication date (Electronic): 20 July 2021

Volume: 17

Issue: 4

Electronic Location Identifier: e290421188337

Affiliations

[1 ] IRCCS Centro Cardiologico Monzino , Milan, , Italy;

[2 ]Department of Biomedical Surgical and Dental Sciences, University of Milan , Milan, , Italy;

[3 ]Department of Cardiovascular Sciences and Community Health, University of Milan , Milan, , Italy

Author notes

Address correspondence to this author at the IRCCS Centro Cardiologico Monzino Via Parea 4 - 20138 Milan, Italy; Tel: +390258002296; Fax: +390258002424; E-mail: marcogennari.md@ 123456gmail.com

Article

Publisher ID: CCR-17-e290421188337

DOI: 10.2174/1573403X16999201124202144

PMC ID: 8762157

PubMed ID: 33238845

SO-VID: 45dc2473-79e0-4e52-83b8-ddc16f642a86

License:

This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) ( https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

History

Date received : 17 June 2020

Date revision received : 15 September 2020

Date accepted : 16 September 2020

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