Clinical characteristics and outcomes of extracorporeal membrane oxygenation used in a non-cardiac surgical intensive care unit: Siriraj experiences and literature review

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has substantially increased in frequency of use over the past decades. Occasionally, patients who require ECMO support are admitted to an ICU rather than medical or cardiac ICU, where physicians may be not familiar with the process of how to care for ECMO patients. The aims of this case series were to explore the utilization of ECMO support in a non-cardiac general surgical ICU (SICU) in terms of indications, ECMO-related complications and clinical outcomes. Methods: Adult patients admitted to the SICU from January 2014 to June 2021 who received ECMO support were included. Demographic data, data regarding ECMO utilization and clinical outcomes were described. Current evidence and updated literature were also researched and reviewed. Results: A total of 18 patients were admitted to the SICU and received ECMO support, but four died within four hours of SICU admission. The most common reason for ECMO support was extracorporeal cardiopulmonary resuscitation (ECPR) (9 cases, 50.0%), followed by cardiac and/or respiratory support. The majority of patients received venoarterial ECMO support (15 cases, 83.3%). Unfractionated heparin was used in 10 cases (71.4%) and the anticoagulant effect was monitored with aPTT, which was maintained at a lower range (30–50 seconds). There was no thromboembolic event, and four patients (28.6%) developed major bleeding. The overall hospital mortality was as high as 77.8%. Conclusion: There was a small volume of cases receiving ECMO support in the SICU. ECPR was the most common reason for ECMO support in these patients. Overall, the hospital mortality was 77.8%. To improve outcomes in these patients, appropriate patient selection, well-organized protocols, and a multidisciplinary approach are mandatory.