Cardiac Tamponade Complicating Extracorporeal Membrane Oxygenation: A Single-Centre Experience

• Type: Article in International Scientific Journal
• Date: 2021

Authors

Basílio, C (Author) Other; Fontoura, A (Author) Other; Fernandes, J (Author) Other; Roncon-Albuquerque R Jr (Author) FMUP; Paiva, JA (Author) Other

Journal

Title: Heart Lung and Circulation

Vol. 30 No. 11

Pages: 1540-1544

ISSN: 1443-9506

Publisher: Elsevier

Indexing

Scopus - 8 Citations

Other information

Authenticus ID: P-00V-26M

DOI: 10.1016/j.hlc.2021.05.078

Abstract (EN): 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. © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

Language: English

Type (Professor's evaluation): Scientific