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

Autores da FMUP

• Roberto Liberal Fernandes Roncon Albuquerque

  Autor

• José Artur Osório De Carvalho Paiva

  Autor

Participantes de fora da FMUP

• Bas?lio, C
• Fontoura, A
• Fernandes, J

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• Medicina

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

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. ? 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)

Keywords

• Extracorporeal membrane oxygenation; Acute respiratory distress syndrome; Acute cardiac failure; Echocardiography; Cardiac tamponade