Definite chest closure after central implantation of extracoroporeal membran oxygenation: A novel solution to prevent complications of the lower limb

Objectives: Extracorporeal membrane oxygenation support is a widely accepted treatment option for patients with cardiogenic shock but is still related with a high incidence of severe complications and death. We present a novel implantation technique to prevent life-threatening vascular complications.

Methods: Between January 2008 and September 2010, a total number of 22 patients with acute myocardial infarction and consecutive cardiogenic shock required ECMO as supportive measure after cardiac surgery. Procedures were isolated CABG, CABG plus valve surgery and CABG plus acquired VSD closure. The implantation of extracorporeal membran oxygenation was performed through the ascending aorta via an 8mm dacron prosthesis and percutaneously through the femoral vein. The chest was closed after implementation of ECMO was completed. For removal, the arterial line was dissected subxyphoidally and the remaining prosthesis was closed by sutures.

Results: Average support duration was 8.7 days. Additional intra-aortic balloon pump was used in 20 patients. Cerebrovascular events occurred in 18.2% and gastrointestinal complications in 9.1%. Acute renal failure was treated with continuous renal replacement therapy in 63.6%. In 9 cases (40.9%) a systemic infection had to be treated. No limb ischemia occurred. 8 (36.4%) patients could successfully be weaned from ECMO and 7 patients (31.8%) were discharged from hospital. CT scan showed thrombosis of the graft without signs of infection after rehabilitation period.

Conclusions: This cannulation strategy offers effective cardiopulmonary support for patients while avoiding limb malperfusion and reducing risk of mediastinitis.