Mehmet ÇAKICI, Evren ÖZÇINAR, Ali İhsan HASDE, Serkan DURDU, Mustafa Bahadır İNAN, Ahmet Rüçhan AKAR, Mustafa SIRLAK, Çağdas BARAN

Eriskin Akut Kardiyojenik Soklu Hastalarda Veno-Arteriyel Ekstra-korporeal Membran Oksijenasyon Desteği: Retrospektif Analiz

Amaç: Ekstrakorporeal Membran Oksijenatör Sistemi (ECMO), respiratuar, kardiyak veya kombine yetmezliği olan hastalarda, hayat kurtarıcı bir teknik olarak kullanılmaktadır. Bu çalısmada, refrakter kardiyojenik sok (RKS) nedeniyle veno-arteriyel ekstrakorporeal membran oksijenasyon (VA-ECMO) desteği gereken hastaların sonuçlarını değerlendirmek amaçlanmıstır. Gereç ve Yöntem: Kliniğimizde, "Mart 2010 - Kasım 2016" yılları arasında, RKS nedeniyle VA-ECMO desteğine alınan hastaların sonuçları retrospektif olarak analiz edildi. Toplam 189 hastaya RKS nedeniyle (127'i erkek, yas ortalaması = 56.6 ± 12.0; BSA ortalaması=1,85 ± 0,19) VA-ECMO implantasyonu yapıldı. Tüm hastaların demografik ve klinik dataları incelendi. Bulgular: Ortalama VA-ECMO desteği süresi, 172.8 ± 234.2 saat (4-1920 saat) olarak hesaplandı. VAECMO desteğinden ayrılabilme (n=92; 48.6 %), toplam survey (n=74, 39.2 %) ve ECMO desteği sırasında görülen vasküler (n=21, 11.1%) ve nörolojik (n=11, 5.8%) komplikasyon oranlarının literatür ile benzerlik gösterdiği tespit edildi. Sonuç: ECMO desteğindeki hastalar çoğunlukla multi-sistemik komplikasyonlara bağlı kaybedilmektedir. ECMO sistemlerindeki ve tekniklerindeki gelisim ile birlikte, mevcut hasta populasyonundaki sağkalım oranları artmakta ve olusabilecek komplikasyon oranları azalmaktadır. Özellikle son on yılda, hibrid ECMO sistemlerinin ve adjuvan kateter aracılı girisimlerin kullanılması, VA-ECMO desteğindeki hastaların hızlı ve güvenli bir sekilde düzelmesine katkı sağlamaktadır. Ülkemizde, daha fazla merkezde, ECMO ile ilgili deneyimin artması, bu tedaviden faydalanan hasta sayısında belirgin artıs olmasını sağlayacaktır.

Veno-Arterial Extracorporeal Membrane Oxygenation Support in Adults With Acute Cardiogenic Shock: A Retrospective Analysis

Aim: Extracorporeal membrane oxygenation (ECMO) appears to be a technically feasible rescue strategy for patients with respiratory and/or circulatory failure. This retrospective study was designed to evaluate and report the outcomes of patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for refractory cardiogenic shock (RCS). Material and Metod: We conducted a retrospective, observational study of consecutive patients with RCS treated with VA-ECMO support at a single transplant center from March 2010 until November 2016. Overall, 189 patients underwent VA-ECMO for RCS (127 men, aged 56.6 ± 12.0 years; BSA, 1.85 ± 0.19). Demographic and clinical data were reviewed for all patients. Results: The mean duration for VA-ECMO support was 172.8 ± 234.2 hours (range; 4-1920 hours). Successful weaning (n=92; 48.6 %), overall survival (n=74, 39.2 %), vascular (n=21, 11.1%) and neurologic (n=11, 5.8%) complication rates were similar in literature. Conclusion: Patients with VA-ECMO support are usually being lost due to multisystemic complications. Improvements in ECMO systems and advanced technical aspects result in better survival and less complication rates in critical patient population. In the last decade, use of hybrid ECMO systems and adjuvant catheter based interventions achieved a fast and safer recovery in this group. Improvement of experience in ECMO in more centres in our country will lead to a significant increase in the number of patients benefitting from this treatment.

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