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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: insights from a Portuguese Cardiac Intensive Care Unit
Session:
Posters 4 - Écran 1 - Doença Coronária
Speaker:
Pedro Miguel Gonçalves Teixeira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Posters
FP Number:
---
Authors:
Pedro Gonçalves Teixeira; Marisa Passos Silva; Domingas Canga Mbala; Miguel Lourenço Varela; Maria Ana Canelas; Ana Raquel Barbosa; Cláudio Guerreiro; Ana Mosalina; Tiago Dias; Pedro Ribeiro Queirós; Eduardo Vilela; Ricardo Fontes-Carvalho; Marta Ponte; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga; Daniel Caeiro
Abstract
<p><strong>INTRODUCTION</strong> Over the past few years, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used to support patients in cardiogenic shock, either as a bridge to myocardial recovery, long-term mechanical circulatory support, or heart transplant. Its use in Portugal in this clinical scenario is rapidly growing, but epidemiologic and clinical outcome data are scarce.</p> <p><strong>PURPOSE</strong> To characterize a Cardiac ICU experience with VA-ECMO support in patients with profound cardiogenic shock over the past decade, providing insights into major clinical outcomes and complications.</p> <p><strong>METHODS</strong> All patients that underwent VA-ECMO support at our Cardiac ICU between September 2011 and October 2018 were included in the analysis. Statistical analyses were conducted using IBM SPSS Statistics 25®.</p> <p><strong>RESULTS</strong> Short-term mechanical support with VA ECMO was given to 40 patients, with a mean age of 52 ± 11 years, of which 52.5% were male. Median door-to-ECMO time was 6 hours [IQR 23]. In 70% of the cases (N=28), the device was placed as a bridge to recovery. Pre-implantation cardiac arrest occurred in 55% (N=22) of patients, with a mean time to ROSC of 17.57 ± 7.5 minutes. The leading cause for VA-ECMO implantation was AMI (37.5%, N=15), followed by acute fulminant myocarditis (22.5%, N=9). Devices for left ventricle venting were simultaneously implanted in 47.5% (N=19), the most frequent being IABP (N=12). At the time of the implant, the mean SAVE Score was -4.75 ± 4.6. CNS dysfunction occurred in 12.8% of patients (N=5), end-stage acute renal failure in 45% (N=18), and hepatic dysfunction in 69.2% (N=27). The great majority of patients were under systemic anticoagulation (94.7%, N=36). Access-related ipsilateral lower limb ischaemic complications occurred in 27.5% (N=11, of which 4 developed compartment syndrome). Access-related hemorrhagic complications occurred in 15% (N=6), those of gastrointestinal origin in 12.5% (N=5), and intracerebral hemorrhage in 2.5% (N=1). Mean ECMO support duration was 116±96 hours. In 70% (N=28) of patients, VA-ECMO was successfully weaned. Mean hospitalization length was 17.5 ±16.0 days. In-hospital mortality was observed in 52.5% of patients, and 30-day mortality in 60%.</p> <p><strong>CONCLUSION</strong> Several advances had been made over the years in VA-ECMO use in this challenging clinical scenario, but broad detailed epidemiologic information on complications and clinical outcomes is needed to improve quality of care.</p>
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