End Organ Recovery and Survival with the QuadroxD Oxygenator in Adults on Extracorporeal Membran Oxygenation

Joshua K. Wong, Vei Shaun Siow, Hitoshi Hirose, Pawel Karbowski, Joseph Miessau, Michael Baram, Matthew DeCaro, Harrison T. Pitcher, Nicholas C. Cavarocchi

Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, USA.
Division of Pulmonary Medicine and Critical Care, Department of Medicine, Thomas Jefferson University, Philadelphia, USA.

DOI: 10.4236/wjcs.2012.24015                

Abstract

Introduction: Extracorporeal Membrane Oxygenation (ECMO) is used in selected patient with cardiogenic and/or re- spiratory shock. We report our experience with standardized management protocols and the application of the Qua- droxD oxygenator with a centrifugal pump to maximize end-organ recovery and improve survival. Methods: This is an Internal Review Board (IRB) approved, single institution retrospective study of end-organ recovery and survival in pa- tients who required ECMO for cardiogenic and/or respiratory shock between July 2010 and June 2011. Results: Sixteen patients (median age: 46 years) were initiated on either Veno-Arterial (VA) or Veno-Venous (VV) ECMO. Cardiogenic shock, acute respiratory distress syndrome (ARDS) and a combined respiratory and cardiogenic compromise were the primary indications for ECMO in 8 (50%), 5 (31%) and 3 (19%) patients respectively. The median time on ECMO was 8 days (range: 4 - 26 days). Twelve patients (75%) were successfully weaned off ECMO, of which four (25%) were bridged to a ventricular assist device (VAD) and eight (50%) were weaned to recovery. All eight patients (100%) that were weaned to recovery and two patients (50%) that were bridged to a VAD were successfully discharged from the hospital, resulting in a discharge rate of 63%. There was an improvement in pre- vs. post-ECMO AST (449 IU/L vs. 63 IU/L, p < 0.05) in 5 patients (31%) with liver injury; serum lactate (9.1 mmol/L vs. 1.9 mmol/L, p < 0.05) in 8 patients (50%); and PaO2/FiO2 ratio (87 to 161, p = 0.01) in 10 patients (62%) with ARDS. Patients with evidence of pulmonary edema (n = 8. 50%) and ARDS (n = 8, 50%) on chest X-ray showed radiographic evidence of complete resolution. Renal function was preserved in 15 patients (94%). Conclusion: ECMO using the QuadroxD oxygenator and a centrifugal pump, coupled with standardized management protocols is beneficial in carefully selected patients. Improvement or main- tenance of end-organ function is associated with successful bridge to device therapy and/or increased survival.

Keywords

Extracorporeal Membrane Oxygenation; Adults; End-Organ Recovery; Mechanical Circulatory Support

Conflicts of Interest

The authors declare no conflicts of interest.

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