Giovanni Cianchi1, Chiara Lazzeri2, Manuela Bonizzoli2, Stefano Batacchi2, Morena Cozzolino2, Marco Ciapetti2, Pasquale Bernardo3, Andrea Franci2, Marco Chiostri2, Adriano Peris2. 1. Emergency Department, Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. Electronic address: giovannicianchi@yahoo.it. 2. Emergency Department, Intensive Care Unit and Regional ECMO Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 3. Heart and Vessels Department, Intensive Cardiac Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Abstract
OBJECTIVE: Many extracorporeal membrane oxygenation (ECMO) centers for respiratory failure and ECMO mobile teams were instituted during the H1N1 pandemic. Data on transportation are scarce and heterogeneous. The authors therefore described the experience of their referral ECMO center for severe respiratory failure from 2009 to 2016 and gave a comprehensive report of transfers performed by their mobile ECMO team. DESIGN: Observational retrospective study. SETTING: An intensive care unit (ECMO referral center) in a teaching hospital. PARTICIPANTS: One hundred and sixty consecutive patients with acute respiratory distress syndrome refractory to conventional treatment requiring veno-venous (VV)-ECMO. INTERVENTION: VV-ECMO implantation. MEASUREMENTS AND MAIN RESULTS: In this series, the transferred patients on ECMO averaged 57%, with annual percentages ranging from 28% to 90% over the years. No adverse event was observed during transportation. A progressive increase in simplified acute physiology score (SAPS) values and in the use of norepinephrine were detectable (p = 0.048 and p = 0.037, respectively) as well as in neuromuscular blockers use (p = 0.004). Dual-lumen cannule were more frequently used in recent years (p < 0.001). The overall mortality rate was 40% (64/160), with no differences over the years or between transferred and local patients. Body mass index and pre-ECMO neuromuscular blockers and SAPS were independent predictors for early mortality (when adjusted for age). CONCLUSIONS: The workload of the authors' referral center and mobile team did not change, documenting that severe respiratory failure requiring VV-ECMO support is still a clinical need. No difference in mortality rate was detectable during this period or between transferred and local patients who were managed by the same team.
OBJECTIVE: Many extracorporeal membrane oxygenation (ECMO) centers for respiratory failure and ECMO mobile teams were instituted during the H1N1 pandemic. Data on transportation are scarce and heterogeneous. The authors therefore described the experience of their referral ECMO center for severe respiratory failure from 2009 to 2016 and gave a comprehensive report of transfers performed by their mobile ECMO team. DESIGN: Observational retrospective study. SETTING: An intensive care unit (ECMO referral center) in a teaching hospital. PARTICIPANTS: One hundred and sixty consecutive patients with acute respiratory distress syndrome refractory to conventional treatment requiring veno-venous (VV)-ECMO. INTERVENTION: VV-ECMO implantation. MEASUREMENTS AND MAIN RESULTS: In this series, the transferred patients on ECMO averaged 57%, with annual percentages ranging from 28% to 90% over the years. No adverse event was observed during transportation. A progressive increase in simplified acute physiology score (SAPS) values and in the use of norepinephrine were detectable (p = 0.048 and p = 0.037, respectively) as well as in neuromuscular blockers use (p = 0.004). Dual-lumen cannule were more frequently used in recent years (p < 0.001). The overall mortality rate was 40% (64/160), with no differences over the years or between transferred and local patients. Body mass index and pre-ECMO neuromuscular blockers and SAPS were independent predictors for early mortality (when adjusted for age). CONCLUSIONS: The workload of the authors' referral center and mobile team did not change, documenting that severe respiratory failure requiring VV-ECMO support is still a clinical need. No difference in mortality rate was detectable during this period or between transferred and local patients who were managed by the same team.
Authors: Mateusz Puslecki; Konrad Baumgart; Marcin Ligowski; Marek Dabrowski; Sebastian Stefaniak; Malgorzata Ladzinska; Ewa Goszczynska; Pawel Marcinkowski; Anna Olasinska-Wisniewska; Tomasz Klosiewicz; Aleksander Pawlak; Marcin Zielinski; Lukasz Puslecki; Roland Podlewski; Lukasz Szarpak; Marek Jemielity; Bartlomiej Perek Journal: Emerg Med Int Date: 2021-02-22 Impact factor: 1.112
Authors: Ryszard Gawda; Maciej Piwoda; Maciej Marszalski; Katarzyna Lyp; Jolanta Piwoda; Magdalena Maj; Maciej Gawor; Maciej Molsa; Marek Pietka; Tomasz Czarnik Journal: Healthcare (Basel) Date: 2022-02-22