Extracorporeal membrane oxygenation in near-drowning patients with cardiac or pulmonary failure.

Abstract

BACKGROUND:

The aim of this study was to determine the early outcomes of using extracorporeal membrane oxygenation (ECMO) in near-drowning patients with cardiac or pulmonary failure.

METHODS:

This study was based on data from 9 patients including 2 children (mean age 33; 8 males, 1 female) who received ECMO after near-drowning between 2008 and 2013. Veno-arterial or veno-arteriovenous ECMO was used in 2 patients with sustained cardiac arrest and veno-venous ECMO was used in 7 patients with severe acute respiratory distress syndrome (ARDS). The means of the partial arterial oxygen pressure (PaO2), Murray score, sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS-II) prior to ECMO were 59.7 ± 9.9 mmHg on 100% oxygen, 3.5 ± 0.6, 11.4 ± 1.9, and 73.0 ± 9.2, respectively.

RESULTS:

The PaO2 mean improved to 182 ± 152 mmHg within 2 h post-ECMO. The mean of SOFA score and SAPS-II decreased significantly to 8.6 ± 3.2 (p = 0.013) and 46.4 ± 5.1 (p = 0.008), respectively, at 24 h post-ECMO with mean flow rate of 3.9 ± 0.8 l/min. ECMO was weaned at a mean duration of 188 (range, 43-672) h in all patients. Seven patients were discharged home without neurological sequelae, while 2 patients who had hypoxic brain damage died after further referral. The overall survival with favourable neurological outcomes at 3 months was 77.8%. There were no complications related to ECMO.

CONCLUSIONS:

ECMO was safe and effective for patients with ongoing cardiac arrest or ARDS after a near-drowning incident and can be used as a resuscitative strategy in near-drowning patients with cardiac or pulmonary failure resistant to conventional ventilator therapy.

• Authors: Kun Il Kim, Won Yong Lee, Hyoung Soo Kim, Jae Han Jeong, Ho Hyun Ko
• Journal: Scandinavian journal of trauma, resuscitation and emergency medicine (Scand J Trauma Resusc Emerg Med) Vol. 22 Pg. 77 (Dec 12 2014) ISSN: 1757-7241 [Electronic] England
• PMID: 25496812 (Publication Type: Journal Article, Observational Study)

Chemical References

• Oxygen

Topics

• Adolescent
• Adult
• Blood Gas Analysis
• Child
• Extracorporeal Membrane Oxygenation (methods)
• Female
• Follow-Up Studies
• Heart Failure (blood, etiology, therapy)
• Humans
• Male
• Middle Aged
• Near Drowning (blood, complications, therapy)
• Oxygen (blood)
• Respiratory Insufficiency (blood, etiology, therapy)
• Retrospective Studies
• Treatment Outcome
• Young Adult