Key result
Modified ECMO is linked to ~60 minutes shorter CABG duration and reduced ICU stay versus CPB.
Why the study?
Conventional cardiopulmonary bypass during coronary bypass surgery causes undesirable side-effects, motivating development of a less invasive modified extracorporeal membrane oxygenation.
Does modified extracorporeal membrane oxygenation improve perioperative outcomes in patients undergoing coronary bypass surgery compared to conventional cardiopulmonary bypass?
Cohort (n=79)
No
Does modified extracorporeal membrane oxygenation improve perioperative outcomes in patients undergoing coronary bypass surgery compared to conventional cardiopulmonary bypass?
Absolute Event Rate: 334% vs 394%
p-value: p=0.001
Modified extracorporeal membrane oxygenation during coronary bypass surgery is associated with shorter operation times, faster postoperative recovery, and reduced myocardial injury compared to conventional cardiopulmonary bypass.
May shorten operative and ICU times in CABG; hypothesis-generating and requires randomized confirmation before practice change.
Objective: Cardiopulmonary bypass offers a stable hemodynamic condition during coronary bypass surgery, but undesirable side-effects emerge as complicating issues. We developed a minimally invasive cardiopulmonary bypass modifying extracorporeal membrane oxygenation to alleviate the side-effects of conventional cardiopulmonary bypass. Herein, we evaluated the effectiveness of the modified extracorporeal membrane oxygenation in coronary bypass surgery. Materials and methods: 79 patients who underwent coronary bypass surgery using cardiopulmonary bypass between January 2014 and March 2019 were divided into those using conventional cardiopulmonary bypass (n=47) and those using the modified extracorporeal membrane oxygenation (n=32). We compared the results of these groups. Results: The operation time in the patients with the modified extracorporeal membrane oxygenation were significantly shorter than those with conventional cardiopulmonary bypass (p =0.001). Heparin and priming volume were less required for the modified extracorporeal membrane oxygenation. The in-hospital mortality and morbidity were comparable between the groups. However, the length of intubation and intensive care unit stay following the operation with the modified extracorporeal membrane oxygenation were significantly shorter than those with conventional cardiopulmonary bypass (p =0.018 and p =0.001, respectively). Furthermore, the creatinine kinase MB isozyme value at the end of the operation with the modified extracorporeal membrane oxygenation was significantly lower than that with conventional cardiopulmonary bypass (p =0.002). Conclusion: Our modified extracorporeal membrane oxygenation seemed less invasive than conventional cardiopulmonary bypass because of the reduced operation time and the early postoperative recovery. This system is beneficial when performing coronary bypass surgery, especially for high-risk patients.
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Hirano et al. (2020) conducted a cohort in Coronary artery disease requiring CABG (n=79). Modified extracorporeal membrane oxygenation (mECMO) vs. Conventional cardiopulmonary bypass (cCPB) was evaluated on Operation time (minutes) (p=0.001). Modified extracorporeal membrane oxygenation significantly reduced operation time (334 vs 394 minutes) and intensive care unit stay compared to conventional cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.
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