Transcript PowerPoint *********

Extracorporeal Membrane Oxygenation
for Bridge to Decision and to Recovery
Shigeki Tabata, Hitoshi Hirose, Nicholas C. Cavarocchi,
James T. Diehl, Hiroyuki Abe
Thomas Jefferson University, Philadelphia, PA
【Objective】
The indications for extracorporeal membrane
oxygenation (ECMO) therapy have since grown to
encompass both respiratory and cardiac failure and are
now being increasingly used in adult patients.
We report a patient who traveled from India to the USA
and developed acute decompensated biventricular
failure and shock requiring ECMO placement as a
bridge to decision.
【Case presentation-1】
A 66-year-old female who traveled from India to the US
presented with severe heart failure and was placed on
V-A ECMO for bridge to decision.
【Chest X-ray before ECMO placement】
Acute pulmonary edema secondary to severe heart failure
【Case presentation-2】
During the first 36 hours the patient lost intrinsic
cardiac rhythm while on ECMO.
On ECMO day 4, a temporary transvenous endocardial
pacing wire was inserted without capture despite
optimal placement.
Ventricular capture was regained 48 hours later.
【Chest X-ray after pacing wire insertion】
【Case presentation-3】
Multiple organ dysfunction as well as neurological
status improved and were maintained by ECMO
support.
Further work-up indicated that the patient was not a
candidate for heart transplant or permanent ventricular
assist device.
ECMO support was continued until there was recovery
from acute decompensated of chronic heart failure.
【Case presentation-4】
ECMO was weaned off with appropriated
pharmacological support.
The patient was weaned to oral heart failure
medications, discharged to a rehabilitation facility and
at home in 1 month.
【Chest X-ray at D/C】
【Discussion-1】
As the technology of the ECMO circuit improved, the
patient care during ECMO has focused on the endorgan recovery. During ECMO support, organs such as
brain, liver, kidney, lungs, gastrointestinal tract and
muscles are well perfused and the temporally
malfunctioned organ due to abrupt cardiopulmonary
failure will have a chance to recover.
In this case, ECMO provided enough flow to vital
organs, improving or maintaining end organ functions.
【Discussion-2】
ECMO is a temporary device and not designed for longterm use.
As the patient was not a candidate for heart transplantation
due to several comorbids and the patient body habitus was
too small for implantable LVAD, The only option left for
this patient was optimal medical treatment.
We performed careful bedside ECMO weaning using TEE
and successfully decannulated ECMO.
【Conclusions】
This is a case of ECMO support for cardiogenic shock
complicated with malignant tachyarrhythmia and
cardiac arrest.
ECMO was able to maintain the organ perfusion
without causing any complications.
ECMO was removed with pharmacological support
without any mechanical cardiac support.