BACKGROUND AND OBJECTIVES: Mechanical circulatory support with extracorporeal membrane oxygenation (ECMO) and ventricular assist device has always been the optimal choice for treating the majority of medically intractable low cardiac output case. We retrospectively investigated our institution's outcomes and variables associated with a high risk of mortality. SUBJECTS AND METHODS: From 1999 to 2014, 86 patients who were of pediatric age or had grown-up congenital heart disease underwent mechanical circulatory support for medically intractable low cardiac output in our pediatric intensive care unit. Of these, 9 grown-up congenital heart disease patients were over 18 years of age, and the median age of the subject group was 5.82 years (range: 1 day to 41.6 years). A review of all demographic, clinical, and surgical data and survival analysis were performed. RESULTS: A total of 45 (52.3%) patients were successfully weaned from the mechanical assist device, and 25 (29.1%) survivors were able to be discharged. There was no significant difference in results between patients over 18 years and under 18 years of age. Risk factors for mortality were younger age (<30 days), functional single ventricle anatomy, support after cardiac operations, longer support duration, and deteriorated pre-ECMO status (severe metabolic acidosis and increased levels of lactate, creatinine, bilirubin, or liver enzyme). The survival rate has improved since 2010 (from 25% before 2010 to 35% after 2010), when we introduced an upgraded oxygenator, activated heart transplantation, and also began to apply ECMO before the end-stage of cardiac dysfunction, even though we could not reveal significant correlations between survival rate and changed strategies associated with ECMO. CONCLUSION: Mechanical circulatory support has played a critical role and has had a dramatic effect on survival in patients with medically intractable heart failure, particularly in recent years. Meticulous monitoring of acid-base status, laboratory findings, and early and liberal applications are recommended to improve outcomes without critical complication rates, particularly in neonates with single ventricle physiology.
Acidosis ; Bilirubin ; Cardiac Output, Low* ; Creatinine ; Critical Care* ; Extracorporeal Membrane Oxygenation ; Heart Defects, Congenital ; Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Infant, Newborn ; Intensive Care Units* ; Lactic Acid ; Liver ; Mortality ; Oxygen ; Oxygenators ; Physiology ; Resuscitation ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors

Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for critically ill patients. Although ECMO is becoming more common, hemorrhagic and thromboembolic complications remain the major causes of death in patients undergoing ECMO treatments. These complications commence upon blood contact with artificial surfaces of the circuit, blood pump, and oxygenator system. Therefore, anticoagulation therapy is required in most cases to prevent these problems. Anticoagulation is more complicated in pediatric patients than in adults, and the foreign surface of ECMO only increases the complexity of systemic anticoagulation. In this review, we discuss the pathophysiology of coagulation, anticoagulants, and monitoring tools in pediatric patients receiving ECMO.
Adult ; Anticoagulants ; Cause of Death ; Critical Illness ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Pediatrics ; Salvage Therapy

Massive pulmonary embolism (PE) is associated with poor prognosis and high mortality. Moreover, patients with massive PE who present with shock have mortality rates ranging from 30% to 50%. Thrombolysis should be administered to patients with massive PE unless there are absolute contraindications to its use. However, treatment failure still occurs, and there is no consensus for the management of massive PE with cardiopulmonary arrest with regard to thrombolysis. In this study, two cases of massive PE with cardiopulmonary arrest are described, both of which were successfully treated with thrombolysis and hemodynamic support, which was administered by extracorporeal membrane oxygenation (ECMO). This report suggests that ECMO may provide safe and adequate cardiopulmonary support in patients with massive PE with refractory thrombolysis and cardiopulmonary arrest.
Consensus ; Extracorporeal Membrane Oxygenation ; Heart Arrest* ; Hemodynamics ; Humans ; Membranes* ; Mortality ; Oxygenators, Membrane* ; Prognosis ; Pulmonary Embolism* ; Shock ; Thrombolytic Therapy ; Treatment Failure

Although heart transplantation is a final therapeutic option in pediatric patients with dilated cardiomyopathy (DCMP), the shortage of pediatric heart donors is a major obstacle. In adults with DCMP characterized by cardiac dyssynchrony, cardiac resynchronization therapy (CRT) is known to be an effective treatment option. However, there is a lack of evidence on the effectiveness of CRT in infants with DCMP. Several studies have reported improvement in hemodynamics and cardiac performance following CRT in infants with DCMP. Here, we report CRT in an infant with DCMP during extracorporeal membrane oxygenation with 5 months of follow-up.
Adult ; Cardiac Resynchronization Therapy* ; Cardiomyopathies ; Cardiomyopathy, Dilated* ; Deoxycytidine Monophosphate ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Heart ; Heart Transplantation ; Hemodynamics ; Humans ; Infant* ; Oxygenators, Membrane* ; Tissue Donors

Recently, the use of extracorporeal membrane oxygenation has evolved rapidly and there is potential for expanding its use. There are many complications associated with extracorporeal membrane oxygenation, but the fracture of a guidewire has been reported to be very rare during extracorporeal membrane oxygenation insertion. We describe our experience of successfully removing a fractured 0.038-inch guidewire using a catheter wedge with balloon inflation following a fracture that occurred during insertion of extracorporeal membrane oxygenation through the left femoral vein.
Catheters ; Device Removal ; Equipment Failure ; Extracorporeal Membrane Oxygenation ; Femoral Vein ; Inflation, Economic ; Membranes* ; Oxygenators, Membrane*

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.
Accelerated Idioventricular Rhythm ; Adult ; Ambulatory Care Facilities ; Arteries ; Back Pain ; Blood Pressure ; Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vessels* ; Dopamine ; Fatigue ; Female ; Follow-Up Studies ; Heart Arrest ; Humans ; Hypotension ; Intensive Care Units ; Norepinephrine ; Operating Rooms ; Oxygenators, Membrane ; Pallor ; Saphenous Vein ; Shock, Cardiogenic ; Spouses ; Transplants

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.
Adult ; Arteries ; Cardiopulmonary Bypass ; Catheterization ; Causality ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Emergencies ; Extracorporeal Membrane Oxygenation ; Heart Failure ; Hemodynamics ; Humans ; Lower Extremity ; Male ; Oxygenators, Membrane ; Spasm* ; Stents ; Transplants*

Myocardial dysfunction can occur during severe sepsis and may accelerate in the condition of chronic decompensated heart failure. A 26-year-old female in remission from non-Hodgkin's lymphoma presented with shock due to chronic heart failure combined with pneumonia. The patient was initially stabilized using a peripheral extracorporeal membrane oxygenator (ECMO) with antibiotics therapy, followed by left ventricular venting due to pulmonary edema that was complicated by left ventricular distension. Here, we report the successful application of ECMO to a patient with pneumonia underlying doxorubicin-induced cardiomyopathy. Although septic conditions remained unclear indication of ECMO, it might be considered a valuable therapeutic option in patients with chronic heart failure.
Adult ; Anti-Bacterial Agents ; Cardiomyopathies ; Doxorubicin ; Extracorporeal Membrane Oxygenation ; Female ; Heart Failure* ; Heart* ; Humans ; Lymphoma, Non-Hodgkin ; Membranes* ; Oxygenators, Membrane* ; Pneumonia* ; Pulmonary Edema ; Sepsis ; Shock

We report on the application of a venovenous type extracorporeal membrane oxygenator (ECMO) in high-risk tracheal procedures in six cases consisting of five patients with tracheal stenosis. An ECMO should be helpful for preventing respiratory emergency during a tracheal procedure.
Emergencies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes ; Oxygenators, Membrane ; Tracheal Stenosis

Eisenmenger syndrome is a severe form of pulmonary arterial hypertension related to congenital cardiac defects. Many patients die at a young age from such complications. The treatment of primary pulmonary hypertension is being applied to Eisenmenger syndrome such as endothelin receptor antagonists, phosphodiesterase-5 blockers, and prostacyclin. We experienced a case of 29-year female with ventricular septal defect-related Eisenmenger syndrome complicated with Down syndrome and Moyamoya disease, who was admitted to intensive care unit due to enteritis-associated septic shock. After the combination treatment with iloprost and sildenafil within the intensive care unit, the patient was able to wean mechanical ventilation without further applications of invasive rescue therapy such as extracorporeal membrane oxygenator. She was later discharged with bosentan. She maintained bosentan therapy for 34 months continuously without aggravations of symptom but eventually died with intracranial hemorrhage, a complication of Moyamoya disease. To our knowledge, this is the first case report of Eisenmenger syndrome accompanied by mosaic Down syndrome and Moyamoya disease.
Cyclic Nucleotide Phosphodiesterases, Type 5 ; Down Syndrome ; Eisenmenger Complex ; Epoprostenol ; Female ; Humans ; Hypertension ; Hypertension, Pulmonary ; Iloprost ; Critical Care ; Intensive Care Units ; Intracranial Hemorrhages ; Moyamoya Disease ; Oxygenators, Membrane ; Piperazines ; Purines ; Receptors, Endothelin ; Respiration, Artificial ; Shock, Septic ; Sulfonamides ; Sulfones ; Sildenafil Citrate