Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: A Single-Centre Experience - 02/09/21
Abstract |
Background |
Cardiac tamponade is a potential complication during extracorporeal membrane oxygenation (ECMO).
Method |
This study assessed the incidence, clinical presentation, therapeutic approach, and outcome of cardiac tamponade at a single ECMO centre during a 10-year period.
Results |
Cardiac tamponade occurred in 11 adults (seven men; age 53 years [range, 48–60]) of 566 patients (1.9%), after 10 days (range, 3–16) of ECMO support: eight veno-venous (VV) and three veno-arterial (VA). Cardiac tamponade was suspected due to haemodynamic deterioration or collapse, and was confirmed by bedside echocardiography. In five of eight VV-ECMO (62%) patients, circulatory arrest ensued and immediate VA-ECMO conversion was performed. Definitive treatment of cardiac tamponade consisted of surgical pericardiotomy in 10 cases: sternotomy (n=8), left minithoracotomy (n=1) and subxiphoid approach (n=1); and pericardiocentesis in one patient. Cardiovascular perforation repair was performed in five patients: two right atrium, two superior vena cava and one pulmonary artery. In the remaining six patients, cardiac tamponade was associated with recent cardiac surgery (n=2), prolonged cardiopulmonary resuscitation (n=1), thoracic trauma (n=1), myopericarditis (n=1), and acute myocardial infarction (n=1). Nine (9) patients (82%) were weaned from ECMO (20 days [range, 11–25]) and eight patients (73%) survived intensive care unit (ICU) (29 days [range, 26–61]) and hospital (34 days [range, 29–81]).
Conclusion |
Cardiac tamponade is a rare but life-threatening complication during both VV-ECMO and VA-ECMO. Echocardiography plays a major role in timely diagnosis and treatment. Immediate conversion to VA-ECMO when circulatory collapse ensued and emergency sternotomy for cardiovascular perforation repair gave favourable outcomes in a high proportion of patients.
Le texte complet de cet article est disponible en PDF.Keywords : Extracorporeal membrane oxygenation, Acute respiratory distress syndrome, Acute cardiac failure, Echocardiography, Cardiac tamponade
Plan
Vol 30 - N° 10
P. 1540-1544 - octobre 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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