The strategy of extracorporeal membrane oxygenation support in the peri-operative period of heart transplantation

LI Ping; Dong Nian-guo; Zhao Yang; Gao Si-hai

doi:10.13498/j.cnki.chin.j.ecc.2014.04.12

Abstract：[ Abstract]:Objective To summarize and analyze the clinical effect and experience of extracorporeal membrane oxygenation ( ECMO) support in the peri-operative period of heart transplant patients in Wuhan Union Hospital. Methods From September 2008 to May 2014, 150 orthotopic heart transplantations were performed in Wuhan Union Hospital, including one case with simultaneous heart-liver transplantation. Eleven patients with severe ventricular failure in the peri-operative period of heart transplant received EC?MO support. One patient received ECMO support because of acute left heart failure during waiting for donor heart;four patients of mar?ginal donor heart transplantation received ECMO support during operation because of low cardiac output after cardiopulmonary bypass;five patients because of right heart failure and one patient because of left heart failure after transplantation received ECMO support. EC?MO was established in these patients by cannulation of VA model. Temperature was maintained between 36-37℃, active clotting time ( ACT) was maintained between 160-180 seconds, mean blood flow was 2.5-3.5 L/min during ECMO assistant period. The hemody?namic and respiratory parameters were maintained stabilization. Results ECMO was weaned off successfully in eight of eleven patients (72.7%). The ECMO time was 15-1532 h and mean time was 315 h. The hemodynamic parameters of eleven patients were improved during ECMO and the dose of vasoactive drugs was decreased. One patient occured catheter-associated ischemia in distal limb, and was treated by using the distal vascular intubation. In addition, there were hemorrhage in two patients, hemolysis in one patient and renal failure in two patients. All these six patients recovered after treatment and discharged successfully. Conclusion ECMO is an important extracorporeal method of life support for heart transplant patients with severe perioperative heart failure, and it can extend the use of mar?ginal donor hearts, which is very important because of the shortage of donor hearts resource today.