Extracorporeal membrane oxygenation in intensive care unit: About the first moroccan experience

Abstract

Introduction Circulatory support and particularly extracorporeal membrane oxygenation (ECMO) has become a possible therapeutic measure to treat children and adults with potentially reversible respiratory and/or heart failure who do not respond to conventional treatment. This technique was introduced recently in Morocco, where the first ECMO was performed in our study. Methods This is a retrospective descriptive monocentric study of 5 patients hospitalized in the mother and child reanimation department at the Hassan II University Hospital in Fez. All patients benefited from ECMO during the period from January 2016 to March 2017. Results We performed 4 VA ECMO and 1 VV ECMO.40% of our patients survived after the introduction of ECMO, while 60% died. Our first case concerns a 12-year-old child suffering from rheumatic fever in whom a VV ECMO was put in place for acute respiratory distress syndrome complicating a mitro-aortic valve replacement surgery for an infective endocarditis. Observation 2 is the experience of a central VA ECMO placed in a 2 years old child, post-cardiotomy of a complex congenital heart disease surgery combining a double outlet right ventricle, interventricular communication and pulmonary arterial hypertension. The 3rd case is a 45-year-old patient carrying a dilated cardiomyopathy with severe biventricular dysfunction and multivisceral failure who benefited from a VA ECMO for a refractory cardiogenic shock as a “bridge to heart transplant”. The 4th patient is an 8-month-old infant with ALCAPA syndrome in whom a VA ECMO was implanted after cardiac coronary reimplantation surgery ( Fig. 1 ). The last case concerns a 56-year-old patient in whom VA ECMO was indicated for cardiogenic shock secondary to fulminant viral myocarditis due to the H3N2 influenza virus. Conclusion Despite the limited number of patients in our study, the introduction of ECMO in Morocco constitutes a major technical advance announcing significant therapeutic progress in the future.