First Experience with Extracorporeal Membrane Oxygenation in Iran, under Difficult Conditions

  • Zargham Hossein Ahmadi, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Farshid Salehi Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Shanay Niusha Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Mohammad Reza Raoufy Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
  • Behrooz Farzaneghan Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Ali Afshar Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Yadollah Mafhoomi Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Zahra Faghih Abdollahi Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Golnar Radmand Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Zahra Ansari Aval Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Alireza Jahangirifard Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords: Extracorporeal membrane oxygenation, Heart failure, Respiratory insufficiency

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) provides hemodynamic and oxygenation support in critical conditions. The commencement of this modality in Iran coincided with severe economic constraints across Iran. Methods: This retrospective study was performed in Masih Daneshvari Medical Center from 2010 to 2015, during which period, sanction-related limitations in the import of equipment prompted us to integrate a Medtronic or Stöckert head pump console into a Maquet ECMO Oxygenator so as to sustain the ECMO program. Comparisons were performed between successful and unsuccessful ECMO procedures and survivors. Factors associated with unsuccessful ECMO were evaluated with a multivariate logistic regression. Results: Thirty-three (68.8%) patients were male and 15 (31.2%) were female. The mean age of the patients was 35±16.6 years. Thirty-seven (77.1%) patients were weaned off ECMO successfully; the rate was higher than that in previous studies. Totally, 35.4% of the study population survived to hospital discharge. The most common cause of death in all the ECMO patients who were successfully weaned was sepsis. The most common cause of death in the patients who underwent unsuccessful ECMO was multisystem organ failure. The mean ECMO support time was 53.37±46.26 hours. The patients who were alive at discharge were significantly younger (25.5±14.5 vs. 40.2±15.5 y; P=0.002) and had a significantly lower ECMO duration (24 [25–75% interquartile: 18.5–36] vs. 48 [25–75% interquartile: 24–72] h; P=0.044) than the non-survivors. Conclusion: An assembly of ECMO components from different companies could be done safely, at least for a short period of time.

Author Biographies

Yadollah Mafhoomi, Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Perfusionist. Bsc.
Zahra Faghih Abdollahi, Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Perfusionist

References

Bartlett RH. Extracorporeal life support: gibbon fulfilled. J Am Coll Surg. 2014;218(3):317-27.

Marasco SF, Lukas G, McDonald M, McMillan J, Ihle B. Review of ECMO (Extra Corporeal Membrane Oxygenation) Support in Critically Ill Adult Patients. Heart, Lung and Circulation. 2008;17, Supplement 4(0):S41-S7.

Sharma AS, Weerwind PW, Maessen JG. Extracorporeal membrane oxygenation resuscitation in adult patients with refractory septic shock. The Journal of Thoracic and Cardiovascular Surgery. 2014;147(4):1441-2.

Jahangirifard A, Hossein Ahmadi Z, Golestani Eraghi M, Tabarsi P, Marjani M, Moniri A, et al. H1N1 Influenza Patient Saved by Extracorporeal Membrane Oxygenation: First Report from Iran. J Tehran Heart Cent. 2016;11(3):153-6.

Ma P, Zhang Z, Song T, Yang Y, Meng G, Zhao J, et al. Combining ECMO with IABP for the Treatment of Critically Ill Adult Heart Failure Patients. Heart, Lung and Circulation. 2014;23(4):363-8.

Patel JK, Schoenfeld E, Parnia S, Singer AJ, Edelman N. Venoarterial Extracorporeal Membrane Oxygenation in Adults With Cardiac Arrest. J Intensive Care Med. 2015;28:0885066615583651.

MacLaren G, Combes A, Bartlett RH. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med. 2012;38(2):210-20.

Nguyen DQ, Kulick DM, Bolman Iii RM, Dunitz JM, Hertz MI, Park SJ. Temporary ECMO support following lung and heart-lung transplantation. The Journal of Heart and Lung Transplantation. 2000;19(3):313-6.

Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002;73(2):538-45.

Formica F, Avalli L, Martino A, Maggioni E, Muratore M, Ferro O, et al. Extracorporeal membrane oxygenation with a poly-methylpentene oxygenator (Quadrox D). The experience of a single Italian centre in adult patients with refractory cardiogenic shock. Asaio J. 2008;54(1):89-94.

Beiras-Fernandez A, Deutsch MA, Kainzinger S, Kaczmarek I, Sodian R, Ueberfuhr P, et al. Extracorporeal membrane oxygenation in 108 patients with low cardiac output - a single-center experience. Int J Artif Organs. 2011;34(4):365-73.

Schopka S, Philipp A, Lunz D, Camboni D, Zacher R, Rupprecht L, et al. Single-center experience with extracorporeal life support in 103 nonpostcardiotomy patients. Artif Organs. 2013;37(2):150-6.

Park M, Azevedo LC, Mendes PV, Carvalho CR, Amato MB, Schettino GP, et al. First-year experience of a Brazilian tertiary medical center in supporting severely ill patients using extracorporeal membrane oxygenation. Clinics. 2012;67(10):1157-63.

Hei F, Lou S, Li J, Yu K, Liu J, Feng Z, et al. Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs. 2011;35(6):572-8.

Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013;15(3):172-8.

Paden ML, Rycus PT, Thiagarajan RR. Update and outcomes in extracorporeal life support. Semin Perinatol. 2014;38(2):65-70.

Prodhan P, Gossett JM, Rycus PT, Gupta P. Extracorporeal membrane oxygenation in children with heart disease and del22q11 syndrome: a review of the Extracorporeal Life Support Organization Registry. Perfusion. 2015;30(8):660-5.

Aubron C, Cheng AC, Pilcher D, Leong T, Magrin G, Cooper DJ, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013;17(2).

Douglass BH, Keenan AL, Purohit DM. Bacterial and fungal infection in neonates undergoing venoarterial extracorporeal membrane oxygenation: an analysis of the registry data of the extracorporeal life support organization. Artif Organs. 1996;20(3):202-8.

O'Neill JM, Schutze GE, Heulitt MJ, Simpson PM, Taylor BJ. Nosocomial infections during extracorporeal membrane oxygenation. Intensive Care Med. 2001;27(8):1247-53.

Burket JS, Bartlett RH, Vander Hyde K, Chenoweth CE. Nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation. Clin Infect Dis. 1999;28(4):828-33.

Sun HY, Ko WJ, Tsai PR, Sun CC, Chang YY, Lee CW, et al. Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg. 2010;140(5):1125-32.

Published
2018-10-15
How to Cite
1.
Ahmadi, ZH, Salehi F, Niusha S, Raoufy MR, Farzaneghan B, Afshar A, Mafhoomi Y, Faghih Abdollahi Z, Radmand G, Ansari Aval Z, Jahangirifard A. First Experience with Extracorporeal Membrane Oxygenation in Iran, under Difficult Conditions. jthc. 13(4):166-72.
Section
Original Article(s)