Abstract
BACKGROUND AND OBJECTIVES:Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation.PATIENTS AND METHODS:From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4.RESULTS:All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO.CONCLUSION:Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care.
Highlights
AND OBJECTIVES: Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems
pumpless extracorporeal lung assist (PECLA) or interventional lung assist is an extracorporeal gas exchange procedure decs signed by an interdisciplinary team at the Department of Cardiothoracic Surgery, University Hospital Regensburg in 1996.7 This arterio-venous bypass proc cedure uses the patient’s blood pressure as the driving force for the blood flow through an oxygenator
Respiratory failure was present in 29 patients, who were provided with PECLA with or without extracorporeal membrane oxygenation (ECMO) (Table 3)
Summary
AND OBJECTIVES: Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. CONCLUSION: Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Interhospital transfer of patients with acute cardiac failure (i.e., cardiogenic shock) to specialized medic cal centers is necessary for patient survival, especialcl ly in highly catecholamine-dependent and mechanically ventilated patients.[1] Patients with severe respiratory failure (acute respiratory distress syndrome) as a result of generalized disease or severe trauma, including militc tary personnel, are another group of patients frequently requiring transport to specialized care institutions.[2,3,4] The use of extracorporeal perfusion systems during transportation minimizes risk and avoids cardiovasculc lar instability.[5] There is little difference between transcp port within a clinical center or between locally separatce ed institutions. This report reviews the technique and equipment required for interhospital extracorporeally assisted transport and evaluates patient outcome in our experience
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
