Sabina P W Guenther1, Stefan Buchholz2, Frank Born2, Stefan Brunner3, René Schramm2, Dominik J Hoechter4, Vera von Dossow4, Maximilian Pichlmaier2, Christian Hagl2, Nawid Khaladj2. 1. Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany. Electronic address: sabina.guenther@med.uni-muenchen.de. 2. Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany. 3. Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany. 4. Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany.
Abstract
OBJECTIVE: Extracorporeal life support (ECLS) emerges as a salvage option in therapy refractory cardiogenic shock but is limited to highly specialized tertiary care centers. Critically ill patients are often too unstable for conventional transport. Mobile ECLS programs for remote implantation and subsequent air or ground-based transport for patient retrieval could solve this dilemma and make full-spectrum advanced cardiac care available to patients in remote hospitals in whom shock otherwise might be fatal. METHODS: From December 2012 to March 2016, 40 patients underwent venoarterial ECLS implantation in remote hospitals with subsequent transport to our center and were retrospectively analyzed. The mobile ECLS team was available 24/7, implantation was performed percutaneously bedside, and compact support systems designed for transport were used. RESULTS: Twenty percent of the patients were female; the mean age was 55 ± 10 years, and the mean Interagency Registry for Mechanically Assisted Circulatory Support score was 1.3 ± 0.5. Patient retrieval was accomplished via ground-based (n = 29, 72.5%, mean distance = 27.9 ± 29.7 km [range, 5.6-107.1 km]) or air (n = 11, mean distance = 62.4 ± 27.2 km [range, 38.9-116.4 km]) transport. No ECLS-related complications occurred during transport. The ECLS system could be explanted in 65.0% (n = 26) of patients, and the 30-day survival rate was 52.5% (n = 21). CONCLUSION: Remote ECLS implantation and interfacility transport on ECLS are feasible and effective. Interdisciplinary teams and full-spectrum cardiac care are essential to achieve optimal outcomes. Rapid-response ECLS networks have the potential to substantially increase the survival of cardiogenic shock patients.
OBJECTIVE: Extracorporeal life support (ECLS) emerges as a salvage option in therapy refractory cardiogenic shock but is limited to highly specialized tertiary care centers. Critically illpatients are often too unstable for conventional transport. Mobile ECLS programs for remote implantation and subsequent air or ground-based transport for patient retrieval could solve this dilemma and make full-spectrum advanced cardiac care available to patients in remote hospitals in whom shock otherwise might be fatal. METHODS: From December 2012 to March 2016, 40 patients underwent venoarterial ECLS implantation in remote hospitals with subsequent transport to our center and were retrospectively analyzed. The mobile ECLS team was available 24/7, implantation was performed percutaneously bedside, and compact support systems designed for transport were used. RESULTS: Twenty percent of the patients were female; the mean age was 55 ± 10 years, and the mean Interagency Registry for Mechanically Assisted Circulatory Support score was 1.3 ± 0.5. Patient retrieval was accomplished via ground-based (n = 29, 72.5%, mean distance = 27.9 ± 29.7 km [range, 5.6-107.1 km]) or air (n = 11, mean distance = 62.4 ± 27.2 km [range, 38.9-116.4 km]) transport. No ECLS-related complications occurred during transport. The ECLS system could be explanted in 65.0% (n = 26) of patients, and the 30-day survival rate was 52.5% (n = 21). CONCLUSION: Remote ECLS implantation and interfacility transport on ECLS are feasible and effective. Interdisciplinary teams and full-spectrum cardiac care are essential to achieve optimal outcomes. Rapid-response ECLS networks have the potential to substantially increase the survival of cardiogenic shockpatients.
Authors: Michiel Morshuis; Frank Bruenger; Tobias Becker; Annette Kempa-Haupt; Lukasz Kizner; Riad Al-Khalil; Jan F Gummert; René Schramm Journal: Ann Cardiothorac Surg Date: 2019-01
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: Thomas Bascetta; Lauri Bolton; Ethan Kurtzman; William Hantzos; Heather Standish; Patricia Margarido; Kathleen Race; John Spencer; William Baker; Jason Gluck Journal: Air Med J Date: 2020-11-28