First Experience with Extracorporeal Membrane Oxygenation in Iran, under Difficult Conditions

Background: Extracorporeal membrane oxygenation (ECMO) provides hemodynamic and oxygenation support in critical conditions. The commencement of this modality in Iran coincided with severe economic constraints across Iran. Methods: This retrospective study was performed in Masih Daneshvari Medical Center from 2010 to 2015, during which period, sanction-related limitations in the import of equipment prompted us to integrate a Medtronic or Stöckert head pump console into a Maquet ECMO Oxygenator so as to sustain the ECMO program. Comparisons were performed between successful and unsuccessful ECMO procedures and survivors. Factors associated with unsuccessful ECMO were evaluated with a multivariate logistic regression. Results: Thirty-three (68.8%) patients were male and 15 (31.2%) were female. The mean age of the patients was 35±16.6 years. Thirty-seven (77.1%) patients were weaned off ECMO successfully; the rate was higher than that in previous studies. Totally, 35.4% of the study population survived to hospital discharge. The most common cause of death in all the ECMO patients who were successfully weaned was sepsis. The most common cause of death in the patients who underwent unsuccessful ECMO was multisystem organ failure. The mean ECMO support time was 53.37±46.26 hours. The patients who were alive at discharge were significantly younger (25.5±14.5 vs. 40.2±15.5 y; P=0.002) and had a significantly lower ECMO duration (24 [25-75% interquartile: 18.5-36] vs. 48 [25-75% interquartile: 24-72] h; P=0.044) than the non-survivors. Conclusion: An assembly of ECMO components from different companies could be done safely, at least for a short period of time.