Case-report: “European medical assisted transfer of a patient with refractory cardiogenic shock supported by extracorporal membrane oxygenation to tertiary care center, a challenge for the future in patient transport?”

Abstract

Purpose of study: European Medical Assisted Transport on May 15th 2010 of post-resuscitation cardiac patient in cardiogenic shock, supported by ExtraCorporal Membrane Oxygenator (ECMO) and Intra-Aortic Balloon Pump (IABP) from NICS to the Tertiary Care RUHC in Strasbourg raised our interest in out-of-hospital Mobile Unit of Cardiac Assistance (MUCA).1Pavie A, Leprince P, Bonnet N, Barreda T, Gandjbakhch I. Interest of the mobile unit of cardiac assistance (MUCA) in critical hemodynamic circumstances. e-Memories of the National Academy of Surgery 2006;5:56–63.Google Scholar Main goal: Assess feasibility of MUCA transport facilities for critical hemodynamic patients in Luxembourg.2Bieniek V. Patient Transport with ECMO: SAMU 38. La revue des SAMU –Médecine d’Urgence 2009; 451–2.Google Scholar Materials and methods: Review of medical literature,3Haft J.W. Pagani D.F. Romano A.M. Leventhal L.Ch. Dyke B.D. Matthews C.J. Short and Long Term Survival of Patients transferred to a Tertiary Care Center on Temporary Extracorporeal Circulatory Support.Ann Thorac Surg. 2009; 88: 711-718Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar related data collected during transport and interviews of implicated staff from concerned hospitals gave us necessary patient-related information about progression of refractory cardiac failure and applied treatment. Results: Medical history: 47-year-old man – first inferior ischemic cardiomyopathic process in 2005 – during second hospital stay starting May 9th 2010: progression of cardiogenic shock with pulmonary edema, reversed ventricular fibrillations – transfer to NICS – diagnosis of severe coronary disease and performance of Percutaneous Coronary Intervention (PCI) and IABP – episodes of ventricular fibrillation with hemodynamic instability and poor left ventricular ejection fraction (20%)-implantation of ECMO and decision to transfer to RUHC for implantation of Left Ventricular Assist Device (VAD) and/or heart transplantation. Despite of difficult circumstances, patient arrived in stable conditions. In Intensive Heart Surgery Care Unit of RUHC, no neurological abnormalities were detected. Renal and hepatic failures were treated with hemodialysis. After 14 days, left ventricular ejection fraction was still beneath 20%. Due to unsuccessful weaning from ECMO, biventricular assist device was implanted. After treatment of septic shock, patient was weaned from ventilation at day 24. Unfortunately, a fatal cerebral hemorrhage occurred 57 days after transfer. Conclusion: This case report underlines the benefits of a well organised MUCA for critical patients in severe cardiogenic shock with refractory cardiac failure.4Vanzetto G. Akret Ch. Bach V. et al.Percutaneous Extracorporeal Circulatory Assistance in acute hemodynamic failure: a monocentric expérience of 100 patients.Can J Cardiol. 2009; 25 (e179–e186)Abstract Full Text PDF PubMed Scopus (41) Google Scholar, 5Riou B, Adnet F, Baud F, et al. Guidelines for indications of circulatory assistance in treatment of refractory cardiac arrests. La revue des SAMU – Médecine d’Urgence 2008: 439–42.Google Scholar European collaboration helped patient and staff in staying hopeful.