EXTRACORPOREAL MEMBRANE OXYGENATION AS A METHOD OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN PATIENTS WITH END-STAGE HEART FAILURE

Abstract

Introduction. Mechanical circulatory support systems are used in three categories of patients. The first group includes patients who cannot be weaned off the circulatory support machine after open-heart surgery (2–8% of patients). The duration of such support ranges from several days to several weeks. The second group includes patients with acute damage to the heart muscle (myocardial infarction, acute myocarditis, etc.). The third group includes patients with chronic severe forms of heart failure. The latter group involves different approaches in determining the strategy for using mechanical circulatory support (MCS): two-stage heart transplantation; reverse cardiac remodeling with repair; permanent pump implantation (DT – destination therapy) in patients for whom HTx is not recommended for certain reasons (age, concomitant diseases preceded by surgery, etc.). Extracorporeal membrane oxygenation (ECMO) is the standard of care for patients with refractory heart failure worldwide, but it is recognized that such advanced procedures should only be performed in specialized centers with high volume and extensive experience. This is a barrier to the introduction of such procedures in other centers that do not yet perform ECMO. However, by 2023, according to the Extracorporeal Life Support Organizations (ELSO), 583 centers were registered, and 14,836 ECMO procedures were performed in adults in 2022. This means that the majority of ECMO therapy is provided in low-volume centers. Therefore, building on the experience of previous years in veno-arterial ECMO therapy, we decided to expand our efforts to improve outcomes for patients with refractory residual heart failure. We describe our initial experience of implementing the ECMO program in the Kovel City District Territorial Medical Association, Kovel-ECMO hospital district (1182) ELSO. Materials and methods. Since the launch of the ECMO program, between January 2023 and November 2024, 25 patients underwent ECMO, reflected according to our protocol, we retrospectively collected preoperative information, treatment course and clinical outcomes. Results. The survival rate (from 3-month follow-up to 1 year) was 56% (14 patients). The successful cannulation rate was 100%. The median cannulation time (minutes) was 15 (10–30) and the median time (minutes) to ECMO was 54 (25–150). The median age was 50 (34–66), 100% were male. It is worth emphasizing that the above results that we report are at least as good as those obtained by many other ELSO member centers that have been operating for several years. Conclusions. Our preliminary results confirm that after implementing appropriate educational programs aimed at all levels of personnel, achieving the necessary technical skills and teamwork, implementing a qualification protocol and procedures based on ELSO recommendations, a new ECMO center can be launched with initial satisfactory results.

Keywords

• extracorporeal membrane oxygenation
• assisted circulation
• heart transplantation
• mechanical circulatory support
• extracorporeal life support organization