Eleven years of extracorporeal membrane oxygenation support in adults in Ukrainian ECMO center - Retrospective study

Introduction: Implementation of an ECMO program in a middle-income country is a challenge, due to high cost and the need for highly skilled staff required. This is a retrospective single center analysis of adult consecutive patients supported on ECMO in ECMO center of Heart Institute Ministry of Health of Ukraine. Materials and methods: Primary outcomes are intensive care unit (ICU) and in-hospital survival. Collected data include age, gender, body mass index, ECMO modes, ECMO indications, location of ECMO cannulation, ECMO duration, use of renal replacement therapy (RRT) and intraaortical balloon pump (IABP), type of oxygenator; length of ICU and hospital stays. Results115 consecutive adult patients (80/70% male) were supported on ECMO between 2012 and 2023. 16 patients (14%) received veno-venous (V-V) support for respiratory failure and 99 (86%) veno-arterial (V-A) support. The median age of the patients was 59 (45; 65) years. The most frequent indication for V-V ECMO was pneumonia in 12 (87%). The indications for V-A cannulation were postcardiotomy ECMO in weaning failure from CPB in 54 (54%), cardiogenic shock in acute coronary syndrome in 19 (19%), and extracorporeal cardiopulmonary resuscitation (ECPR) in 19 (19%) of cases. ECMO was provided for primary graft dysfunction after heart transplantation (HTx) in 5 (5%) and as a bridge to HTx in 2 (2%) cases. ICU and in-hospital survival for V-V ECMO were 56% and 50%, for V-A ECMO, 46% and 44%, respectively. ECPR for in-hospital cardiac arrest survival rates were 37% and 32%. Conclusion: Our limited resources ECMO center has comparable ECMO outcomes reported in the ELSO registry. Nevertheless, it is important to establish an "ECMO rescue chain" to improve organization of ECMO care in Ukraine.