Five years of VV ECMO for severe respiratory failure in a Latin American cardiovascular center

Daniel Manzur-Sandoval, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Gian M. Jiménez-Rodriguez, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Rodrigo Gopar-Nieto, Unidad de Urgencias y Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Guadalupe L. Hernández-González, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Luis A. Morgado-Villaseñor, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Gustavo Rojas-Velasco, Unidad de Cuidados Críticos Cardiovasculares, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Background: Venovenous extracorporeal membrane oxygenation (VV ECMO) is a fundamental strategy in the management of refractory respiratory failure. In this context, the National Institute of Cardiology Ignacio Chávez (INCICh) has implemented VV ECMO within its cardiovascular intensive care unit (CICU). Objective: To describe the experience and clinical outcomes of VV ECMO use in patients with severe respiratory failure in a Latin American cardiovascular center. Method: A retrospective observational study was conducted including patients who received VV-ECMO support at INCICh. Demographic, clinical, and hemodynamic variables, cannulation type, duration of support, complications, and hospital outcomes were analyzed. The primary outcome was in-hospital mortality. Data were analyzed using nonparametric tests and Kaplan-Meier survival curves. Results: Twenty patients were included, with a median age of 41.5 years (IQR: 23-59) and a predominance of males (80%). The main indication was respiratory failure due to SARS-CoV-2 infection (55%). In-hospital survival was 70%, higher than that reported in international series. Comorbidities and anthropometric variables were not associated with mortality. Non-survivors had longer stays in the CICU, mechanical ventilation, and ECMO support, though without statistical significance. Acute kidney injury was the most frequent complication, with no direct impact on mortality. Conclusions: VV-ECMO therapy at INCICh demonstrated lower mortality compared with other series, underscoring the importance of specialized teams and established protocols to optimize outcomes in patients with refractory respiratory failure.

Keywords: Extracorporeal membrane oxygenation. Acute respiratory distress syndrome. Intensive care unit. COVID-19.