Heart surgery

Early implantation of extracorporeal membrane oxygenator after open heart surgery

The extracorporeal membrane oxygenator (ECMO) is effective in maintaining oxygenation and hemodynamic support in patients with post-cardiotomy cardiogenic shock (PCCS). The researchers, led by Ahmed Abdeljawad, sought to compare the effect of early implantation of ECMO in emergency patients versus elective patients who developed univentricular or biventricular pump failure. After their trial, they suggested that “early use of ECMO in high-risk emergency cardiac surgeries should be considered when possible, without hesitation.”

Their article, published in Cardiac Surgery Forumalso reported that “urgent and elective patients benefit equally from ECMO implantation and have comparable complication rates,” further supporting the value of early ECMO implantation for patients with refractory PCCS.

The trial included 35 patients who received ECMO between 2019 and 2021 after developing refractory PCCS. The patients were classified into two groups; Group A was composed of 18 patients operated on urgently, while group B was composed of 17 patients operated on electively. ECMO was implanted by central cannulation (right atrium and ascending aorta) or by peripheral cannulation (femoral vessels or axillary artery).

Abdeljawad and colleagues reported no statistically significant differences between the two ECMO groups regarding preoperative patient characteristics, complication rates, duration of mechanical ventilation, hospital stay after weaning from ECMO, ICU length of stay, in-hospital mortality, number of patients discharged from hospital, or one-year survival during follow-up.

The high degree of similarity in ECMO implantation outcomes between emergency and elective patients led the study authors to strongly recommend the early application of ECMO to treat refractory PCCS in patients. heart surgery patients.