Transplantologiya 2014

Table 1. Clinical situations that may prompt the ECMO use

Respiratory failure	• Respiratory distress syndrome
	• Pneumonia (viral, bacterial)
	• Aspiration (including drowning)
	• Upper airway burns
	• Pulmonary embolism and reperfusion syndrome
Cardiac indications	• Postcardiotomy syndrome
	• Myocarditis
	• Acute myocardial infarction with a cardiogenic shock refractory to a conventional therapy (ruptured mitral chordae tendineae, ventricular septal defect)
	• Cardiac contusion
	• Refractory arrhythmia with a fall in a cardiac output
	• Cardiopulmonary resuscitation
Critical situations after cardiac surgery in the operating room	• Failure to wean from a cardiopulmonary bypass
	• Refractory ventricular arrhythmias with a fall in a cardiac output
	• Failure to maintain adequate hemodynamics, despite the infusion of cardiotonic agents in high doses.
	• Cardiac arrest non-responding to standard resuscitation efforts
As "a bridge" to transplantation	• Life support of a patient while waiting for a heart or/and lung transplantation

ECMO makes it possible to transport the patient to a specialized clinical facility, to render care to a victim who sustained a severe multisystem trauma (as a result of a road accident), to deliver a patient from the site of an accident to the University Hospital for a specialized medical care, and also to undertake in-hospital transports (Fig.3).

Figure 3. Transportation of patients on ECMO

At the time of our visit to the clinic, 8 ECMOs of various types were undertaken in the ICUs. The patient population was as follows: 1 patient in condition after coronary artery bypass surgery whose postoperative course was complicated by the respiratory failure developed secondary to pneumonia (Fig. 4); 2 non-surgical patients with a decompensated respiratory failure secondary to a community-acquired pneumonia; 2 other patients who had sustained a severe multisystem trauma complicated by ARDS; 1 patient with multiple etiology pneumonia who received immunosuppression therapy after liver transplantation; 2 patients with decompensated heart failure awaiting for a heart transplantation.

Figure 4. ECMO in a patient after a coronary artery bypass surgery who developed a respiratory failure

Patients with a respiratory failure had a veno-venous ECMO and those waiting for a heart transplantation had a veno-arterial ECMO (Fig.5, 6). An ECMO procedure was performed as a component in a complex of intensive care measures in ICU beds of relevant departments. In Regensburg University Hospital, each ICU bed is outfitted with a complete set of necessary medical equipment and monitoring devices. Each ICU is arranged to have a laboratory module equipped with blood gas and electrolyte analyzers, and the machine to assess the blood activated clotting time. All the equipment related to the diagnostic and treatment process is connected to a central information system, the access to its data being available from anywhere in the clinic.

Figure 5. The scheme of peripheral veno-venous ECMO.

Figure 6.The scheme of peripheral veno-arterial ECMO.

The indications to ECMO initiation are based on nosological diagnoses and include the development of respiratory and/or cardiac failure (Table.2).