The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 439
Slide Session
OS-108 Critical Care
Infections during Extracorporeal Membrane Oxygenation Use in Adult Patients
Dong Wan Kim1, Woo Hyun Cho1, Yun Seong Kim1, Doo Soo Jeon1, Do Hyung Kim1, Bong Soo Son1
Pusan National University YangSan Hospital, Korea1
Background: The extracorporeal membrane oxygenation (ECMO) use in adult patients has been increasing, but little is known about infections during ECMO.
Methods: We retrospectively analyzed the medical records of adult patients who received ECMO support for more than 48 hours at Pusan National University Yangsan Hospital from 2012 to 2014. Cases of bloodstream infection (BSI) and ventilator-asso- ciated pneumonia (VAP) that occurred in patients who received ECMO were analyzed.
Results: A total of 61 ECMO procedures were performed for more than 48 hours in 59 patients, and 19 patients had a total of 27 infections (37.3 infectious episodes per 1000 ECMO days). They includes 15 cases of BSI, of which 8 were in patients with VAP and 4 were in patients with catheter-related blood stream infection (CRBSI); 12 cases of VAP. Acinetobacter baumannii (31.6%) and Enterococcus faecium (26.3%) were in predominant blood isolates. The number of days of ECMO use was independently associated with a risk of infection (P=0.001). Infected patients had a higher intensive care unit (ICU) mortality and a longer ICU length of stay compared with uninfected patients (P=0.014 and P=0.023, respectively).
Conclusions: The probability of infection increased with the duration of ECMO. Infec- tions affected ICU mortality and ICU length of stay.
OS-109 Critical Care
Lung Transplantation in Patients with Acute vs Chronic Respiratory Failure with Extracorporeal Membrane Oxygenator
Dong Hyun Lee1, Sang Oh Lee2, Tae Sun Shim1, Sae Hoon Choi3, Hyung Ryul Kim3, Yong Hee Kim3, Dong Kwan Kim3, Seung Il Park3, Sang-Bum Hong1
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea1, Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Korea2, Department of Chest Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea3
Background: Because acute respiratory failure often results in irreversible pulmonary damage with high mortality, lung transplantation might be one of the last option for these patients. However, there are few reports about this issue.
Methods: From January 2011 to December 2013 we retrospectively reviewed respira- tory failure patients with extracorporeal membrane oxygenator (ECMO) support and subsequently treated with lung transplantation.
Results: Seventeen patients underwent lung transplantation surgery from irreversible respiratory failure during ECMO support. Seven patients were female and mean age was 44.5 ± 12.1 years. Overall observation duration was 534.2 ± 469.3 days. Ten patients had acute respiratory failure and 7 patients had chronic respiratory failure.
Although the disease entity of the both groups was distinct, the duration of treatment with ECMO, intensive care unit stay and hospital stay, and clinical outcomes of acute respiratory failure patients were comparable to the chronic respiratory failure with ECMO. (Table 1)
Conclusions: Lung transplantation in patients with acute respiratory failure with ECMO support exhibits comparable results to those with chronic respiratory failure with ECMO.
OS-110 Critical Care
Comparison of Clinical Outcomes between Conventional and Conservative Anticoagulation Strategy for
Extracorporeal Membrane Oxygenation in Adults: A Single-Center Experiences
Hye Ju Yeo1, Dong Wan Kim1, Seong Hoon Yoon1, Seung Eun Lee1, Woo Hyun Cho1, Bong Soo Son1, Do Hyung Kim1, Doosoo Jeon1, Yun Seong Kim1
Pusan National University YangSan Hospital, Korea1
Background: Anticoagulation is a key component in running extracorporeal membrane oxygenation (ECMO). Anticoagulation, however, is related with serious bleeding com- plications. Previous studies suggested that bleeding complications are more commonly related to serious morbidity and mortality than thromboembolic ones. In this study, we hypothesized that lower dose of anticoagulation may be safe and effective and assessed the clinical outcomes according to different anticoagulation strategies.
Methods: We reviewed retrospective data of ECMO database from December 2008 to March 2014. In the conventional group, anticoagulation targeted to maintain an acti- vated clotting time (ACT) in between 180 and 220 seconds by a continuous infusion of unfractionated heparin. In the conservative group, anticoagulation targeted to activated partial thromboplastin time (aPTT) in between 50 and 70 seconds. We assessed the inci- dence of bleeding events, transfusion requirements, thromboembolic complications, and other clinical outcomes in each strategy.
Results: A total of 626 days on ECMO in 58 patients were reviewed. The 59 percent of the patients receiving ECMO therapy were successfully weaned and the overall mortality was 50 percent. Overall, 40 percent of the patients (n=23) were treated with conven- tional anticoagulation strategy (S group) and 60 percent of the patients (n=35) were treated with conservative anticoagulation strategy (C group). Incidences of major bleed- ing and bleeding related death were signifi cantly lower in the C group (57% versus 29%, p=0.033 and 13% versus 0%, p=0.028). The average daily transfusion doses of RBC unit and FFP were higher in the S group (3.4 versus 1.4, p=0.001, 2 versus 0.6, p=0.000).
Conclusions: In this study, conservative anticoagulation strategy showed acceptable results in terms of major bleeding event, transfusion dose and thromboembolic compli- cations. Such results make conservative anticoagulation strategy capable of reducing bleeding complications without serious thrombotic complication.
