Extracorporeal membrane oxygenation in resource-limited countries

Clinical characteristics and outcomes of adults with peripheral extracorporeal membrane oxygenation in a developing country: A single center 8-year retrospective study

INTRODUCTION

In our institute, we began using peripheral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) in 2010, and peripheral veno-venous (VV) ECMO in 2015. This study aimed to describe clinical characteristics and outcomes in those patients.

METHODS

We reviewed retrospective data of adults receiving peripheral ECMO from January 2010 to December 2017 and divided it into two groups for analysis: VA- and VV-ECMO.

RESULTS

There were 28 patients in the VA group and 12 in VV. For VA, the mean (SD) age was 58.5 (17.2) years. The most common indication was cardiac arrest (12 patients, 42.9%); 15 patients (53.6%) were on intra-aortic balloon pump concomitantly. In the VV cohort, the mean age was 53.3 (16.2) years. Eleven (91.7%) patients had acute respiratory distress syndrome as an indication. The mortality rate of VA-ECMO was 85.7%, and VV was 58.3%.

CONCLUSION

The mortality rate in our ECMO center was considerably higher than that in the international registry report. Improved team education, rigid patient selection criteria, and a reimbursement protocol should lead to ameliorated outcomes.

TRIAL REGISTRATION

TCTR20190120001. Registered January 19, 2019.

Extracorporeal Circulation Membrane Oxygenation Therapy for Acute Respiratory Diseases

Extracorporeal circulation membrane oxygenation provides pulmonary and/or cardiac support over a limited period of time for severe reversible cardio pulmonary diseases. It is an invasive technique with large risks associated but an improved survival rate of around 80%. It has strict selection criteria for neonatal and pediatric patients. The main complications are hemorrhage, stroke, convulsions, cardiac failure, kidney failure, arterial hypertension, and hemolysis. Extracorporeal circulation membrane oxygenation must be implemented only in high-complexity neonatal and pediatric centers with trained personnel.

Neonatal and pediatric extracorporeal membrane oxygenation in developing Latin American countries

OBJECTIVE

To review the principles of neonatal-pediatric extracorporeal membrane oxygenation therapy, prognosis, and its establishment in limited resource-limited countries in Latino America.

SOURCES

The PubMed database was explored from 1985 up to the present, selecting from highly-indexed and leading Latin American journals, and Extracorporeal Life Support Organization reports.

SUMMARY OF THE FINDINGS

Extracorporeal membrane oxygenation provides "time" for pulmonary and cardiac rest and for recovery. It is used in the neonatal-pediatric field as a rescue therapy for more than 1300 patients with respiratory failure and around 1000 patients with cardiac diseases per year. The best results in short- and long-term survival are among patients with isolated respiratory diseases, currently established as a standard therapy in referral centers for high-risk patients. The first neonatal/pediatric extracorporeal membrane oxygenation Program in Latin America was established in Chile in 2003, which was also the first program in Latin America to affiliate with the Extracorporeal Life Support Organization. New extracorporeal membrane oxygenation programs have been developed in recent years in referral centers in Argentina, Colombia, Brazil, Mexico, Perú, Costa Rica, and Chile, which are currently funding the Latin American Extracorporeal Life Support Organization chapter.

CONCLUSIONS

The best results in short- and long-term survival are in patients with isolated respiratory diseases. Today extracorporeal membrane oxygenation therapy is a standard therapy in some Latin American referral centers. It is hoped that these new extracorporeal membrane oxygenation centers will have a positive impact on the survival of newborns and children with respiratory or cardiac failure, and that they will be available for an increasing number of patients from this region in the near future.