gms | German Medical Science

Introduction: Pulmonary failure (ARDS) is associated with a high mortality. The experience with veno-venous extracorporeal membrane oxygenation (vv-ECMO) in a surgical population is reported.

Materials and methods: A retrospective analysis on n=148 pts requiring vv-ECMO support between April 2006 and September 2010 was applied. Nineteen patients developed ARDS after elective or urgent major surgery (S) including abdominal, orthopaedic and cardiac interventions. Another n=15 patients developed ARDS as a consequence of a severe trauma (T). The non-surgical (NS) population consisted of n=113 pts. Statistical comparisons were executed.

Results: Patients requiring primarily surgery (S) were elder (mean age = 59±13 years) compared to trauma (T) patients requiring surgery (mean age = 32±17 years; p<0.001) and to the non-surgical (NS) population (mean age = 49±16 years; p=0.008). Pulmonary failure was mainly caused by pneumonia, sepsis, aspiration or/and due to chest contusion in several trauma patients. Vv-ECMO support was implemented in n=4 patients (S=2 pts ;T=2 pts) during their primary surgical intervention as a rescue action withholding anticoagulation postoperatively up to 48 hours. In the remaining patients vv-ECMO was installed electively on the intensive care unit after surgery. Oxygenation improved immediately after initiating vv-ECMO, within two hours the PaO₂/FiO₂ ratio rose from 80±42 mmHg to 129±72 mmHg (p=0.001). Support duration was slightly longer in Spatients compared to Tpatients, but shorter compared to the NSpopulation. Blood and platelet transfusion requirement did not differ between groups (Table 1 [Tab. 1]). The survival to discharge was 48% in the Sgroup compared to 80% in trauma patients (p=0.055). The NSpopulation depicted a survival of 50%.

Conclusion: The outcome in patients suffering from pulmonary failure after major surgery is comparable to the outcome of non- surgical patients also with regards to transfusion requirements. The outcome in trauma patients requiring vv-ECMO is excellent (Figure 1 [Fig. 1]).