The Role of Extracorporeal Membrane Oxygenation in The Protective Lung Strategy after Cardiac Surgery in a Tertiary Intensive Care Unit
Ibrahim Mungan, Sema Turan
Abstract
Background: In cases of respiratory failure, Lung-Protective Ventilation Strategy (LPVS) which limits ventilator-induced lung injury is recommended. However, CO2 retention is a major impediment for LPVS and Extracorporeal membrane oxygenation (ECMO) supplies enough time to the lungs for rest and recovery. We aimed to find out the connection between ECMO usage and the reduction of mechanical ventilatory values in patients who required ECMO therapy after cardiac surgery due to pulmonary failure.
Methods: In this retrospective cohort study, we analyzed 21 consecutive patients receiving a venovenous ECMO for pulmonary failure after cardiac surgery and 19 patients non-ECMO group. Demographic variables including age, gender, predicted body weight, and heart rate and the arterial blood gas analysis data, mechanical ventilator parameters and clinical outcomes were derived from institutional database.
Results: The mean age of the patients was 55.57 years and ECMO patients were younger than non-ECMO group patients (p=0.005). The other descriptive variables and clinical parameters did not differ between groups statistically. The mechanical ventilator parameters and arterial blood gas analysis were worse in the ECMO group before the procedure (p <0.001) whereas improvement in data was more significant in the ECMO group after the procedure (p<0.001 in Pplateau and PaO2) . The patients in the non-ECMO group stayed longer in hospital (35.68 days vs 16.9 days) and in ICU (31.11 days vs 13.33 days) than the patients in the ECMO group. The duration of the mechanical ventilatory support did not differ between groups.
Conclusion: The intensivists had a big dilemma involving the balance between maintaining a sensible blood-gas exchange and protecting the lung from adverse effects of mechanical ventilatory support. The extracorporeal life support –ECMO- was advised until the pulmonary failure was resolved. We found that ECMO support was decreasing the high Plateau Pressure and respiratory rate more than the non-ECMO group.
Keywords
References
1. Chiumello D, Carlesso E, Brioni M, Cressoni M. Airway driving pressure and lung stress in ARDS patients. Crit Care. 2016;20:276. doi:10.1186/s13054-016-1446-7.
2. Patroniti N, Bonatti G, Senussi T, Robba C. Mechanical ventilation and respiratory monitoring during extracorporeal membrane oxygenation for respiratory support. Ann Transl Med. 2018;6(19):386. doi: 10.21037/atm.2018.10.11.
3. Wu MY, Chang YS, Huang CC, Wu TI, Lin PJ. The impacts of baseline ventilator parameters on hospital mortality in acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: a retrospective cohort study. BMC Pulm Med. 2017;17(1):181. doi: 10.1186/s12890-017-0520-5.
4. Sen A, Callisen HE, Alwardt CM, Larson JS, Lowell AA, Libricz SL, et al. Adult venovenous extracorporeal membrane oxygenation for severe respiratory failure: Current status and future perspectives. Ann Card Anaesth. 2016;19(1):97-111. doi: 10.4103/0971-9784.173027.
5. Finney SJ. Extracorporeal support for patients with acute respiratory distress syndrome. Eur Respir Rev. 2014;23(133):379–389. doi: 10.1183/09059180.00005514.
6. Mungan İ, Kazancı D, Bektaş Ş, Ademoglu D, Turan S. Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study. BMC Anesthesiol. 2018;18(1):152. doi: 10.1186/s12871-018-0618-1.
7. Lorusso R, Alexander P, Rycus P, Barbaro R. The Extracorporeal Life Support Organization Registry: update and perspectives. Ann Cardiothorac Surg. 2019;8(1):93-8. doi: 10.21037/acs.2018.11.03.
8. Badenes R, Lozano A, Belda FJ. Postoperative pulmonary dysfunction and mechanical ventilation in cardiac surgery. Crit Care Res Pract. 2015;2015:420513. doi: 10.1155/2015/420513.
9. Young RW. Prevention of lung injury in cardiac surgery: a review. J Extra Corpor Technol. 2014;46(2):130-41.
10. Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: A systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth 2018; 32:1922-36. doi: 10.1053/j.jvca.2017.10.031.
11. Rodrigues CD, Oliveira RA, Soares SM, Figueiredo LC, Araújo S, Dragosavac D. Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão. Rev Bras Ter Intensiva. 2010;22(4):375-83. doi: https://doi.org/10.1590/S0103-507X2010000400011.
12. Papazian L, Aubron C, Brochard L, Chiche JD, Combes A, Dreyfuss D, et al. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care. 2019;9(1):69. doi:10.1186/s13613-019-0540-9.
13. Schmidt M, Pellegrino V, Combes A, Scheinkestel C, Cooper DJ, Hodgson C. Mechanical ventilation during extracorporeal membrane oxygenation. Crit Care. 2014;18(1):203. doi: 10.1186/cc13702.
14. Zhang Z, Gu WJ, Chen K, Ni H. Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure. Can Respir J. 2017;2017:1783857. doi: 10.1155/2017/1783857.
15. López Sanchez M. Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO). Med Intensiva 2017;41:491-6. di: 10.1016/j.medin.2016.12.007.
Submitted date:
02/20/2020
Reviewed date:
04/05/2020
Accepted date:
04/07/2020
Publication date:
04/07/2020
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email