Ecmo in change-from ultima ratio to first line therapy an interdisciplinary approach

BackgroundSince the first successful operation with left heart bypass performed by Dodrill in Michigan in 1952 (The Michigan Heart) and the first successful application of the heart lung machine in 1953 performed by Gibbon the extracorporeal circulation has become a conditio sine qua non in cardiac surgery. Through the last decades extracorporeal circulation has become an important therapeutic tool not only in cardiac surgery. It is used in several indications in neonatology, pediatrics, oncology, and vascular surgery. The most important indication next to cardiac surgery is the use as ECMO in intensive care medicine to treat patients with ARDS, cardiac failure, severe lung embolism and sepsis.MethodsBetween January 2005 and April 2012, 311 ECMO were implanted in our hospital. In 79 patients a venovenous System was implanted, in 230 patients we performed a venoarterial ECMO and in 2 patients we used a second venous approach as a venovenousarterial ECMO. Different Oxygenators (Quadrox®, ECCO®, Eurosets®and Medtronic®) and different Systems.(Levitronics®, Medtronic®, Lifebridge®, Medos®and Cardiohelp®) were used.ResultsThe average survival in Patients allover is 46%. The highest survival rate is shown in the department for cardiac surgery with 68%. The highest Mortality is shown in the department for internal medicine with 66%. Different Indications, Risk factors, time of Implantation and learning curve might be some reasons for this difference in outcome. It is also shown that we could decrease Mortality in Patients treated with an ECMO in cardiac surgery through the last 5 Years from almost 80% to 32 %.ConclusionECMO has become an important therapy part in the management of different medical emergencies such as ARDS, cardiogenic shock, severe lung embolism and sepsis. By increasing in hospital experience in hemodynamically and respiratory compromised patients we established an interdisciplinary ECMO program and decreased mortality in such emergencies. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra-and inter-hospital transport. The team approach between Cardiac surgery, Anesthesia, Perfusion and internal medicine was not only a gain on security it is an option to develop ECMO further