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Dünser MW, Noitz M, Tschoellitsch T, Bruckner M, Brunner M, Eichler B, Erblich R, Kalb S, Knöll M, Szasz J, Behringer W, Meier J. Emergency critical care: closing the gap between onset of critical illness and intensive care unit admission. Wien Klin Wochenschr 2024:10.1007/s00508-024-02374-w. [PMID: 38755419 DOI: 10.1007/s00508-024-02374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024]
Abstract
Critical illness is an exquisitely time-sensitive condition and follows a disease continuum, which always starts before admission to the intensive care unit (ICU), in the majority of cases even before hospital admission. Reflecting the common practice in many healthcare systems that critical care is mainly provided in the confined areas of an ICU, any delay in ICU admission of critically ill patients is associated with increased morbidity and mortality. However, if appropriate critical care interventions are provided before ICU admission, this association is not observed. Emergency critical care refers to critical care provided outside of the ICU. It encompasses the delivery of critical care interventions to and monitoring of patients at the place and time closest to the onset of critical illness as well as during transfer to the ICU. Thus, emergency critical care covers the most time-sensitive phase of critical illness and constitutes one missing link in the chain of survival of the critically ill patient. Emergency critical care is delivered whenever and wherever critical illness occurs such as in the pre-hospital setting, before and during inter-hospital transfers of critically ill patients, in the emergency department, in the operating theatres, and on hospital wards. By closing the management gap between onset of critical illness and ICU admission, emergency critical care improves patient safety and can avoid early deaths, reverse mild-to-moderate critical illness, avoid ICU admission, attenuate the severity of organ dysfunction, shorten ICU length of stay, and reduce short- and long-term mortality of critically ill patients. Future research is needed to identify effective models to implement emergency critical care systems in different healthcare systems.
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Affiliation(s)
- Martin W Dünser
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria.
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, Krankenhausstraße 9, 4020, Linz, Austria.
| | - Matthias Noitz
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Thomas Tschoellitsch
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Markus Bruckner
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Markus Brunner
- Ambulance and Disaster Relief Services, Oberösterreichisches Rotes Kreuz, 4020, Linz, Austria
| | - Bernhard Eichler
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Romana Erblich
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Stephan Kalb
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | - Marius Knöll
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
| | | | - Wilhelm Behringer
- Department of Emergency Medicine, Vienna General Hospital, 1090, Vienna, Austria
| | - Jens Meier
- Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital and Johannes Kepler University, 4020, Linz, Austria
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Narita K, Amiya E, Hatano M, Ishida J, Minatsuki S, Tsuji M, Bujo C, Kakuda N, Isotani Y, Ono M, Komuro I. Determining the factors for interhospital transfer in advanced heart failure cases. IJC HEART & VASCULATURE 2022; 40:101035. [PMID: 35601528 PMCID: PMC9118470 DOI: 10.1016/j.ijcha.2022.101035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 01/22/2023]
Abstract
Background There are some patients with advanced heart failure (HF), for whom implantable left ventricular assist device (LVAD) or heart transplantation (HTx) should be considered. Some of them need to be transferred between hospitals. There are few reports on the interhospital transfer of patients with advanced HF and their subsequent clinical course. In this study, we investigated the characteristics and clinical course of patients transferred to a LVAD/HTx center, focusing on the distance between hospitals. Methods We retrospectively examined 141 patients who were transferred to our hospital, considering the indications of LVAD implantation or HTx. We divided the patients into two groups: those referred <33 km (short-distance) and those referred more than 33 km (long-distance). The primary outcome was the composite outcome of increased catecholamine dose, mechanical support, or renal dysfunction within 1 week of transfer. Results Continuous catecholamine infusion was significantly more common in patients in the long-distance group, whereas extracorporeal membrane oxygenation (ECMO) placement was significantly more common in short-distance group. Patients transferred via long distance had significantly higher rates of increased catecholamine doses, mechanical support including intra-aortic balloon pumping (IABP) and ECMO, and renal dysfunction within 1 week of transfer than patients transferred via short distance. Multivariate analysis showed that low body mass index (BMI) and long distance were independent predictive factors for the primary outcome. Conclusions When patients with advanced HF are transferred from far distant hospitals or with low BMI, it may be necessary to devise various measures for interhospital transport.
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Affiliation(s)
- Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.,Department of Therapeutic Strategy for Heart Failure, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan.,Advanced Medical Center for Heart Failure, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Junichi Ishida
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Masaki Tsuji
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Chie Bujo
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Nobutaka Kakuda
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Yoshitaka Isotani
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, Japan
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Javidfar J, Labib A, Ragazzo G, Kurtzman E, Callahan M, Heinsar S, Gudzenko V, Barrett P, Binongo J, Wei JW, Fraser J, Suen JY, Li Bassi G, Peek G. Mobile Extracorporeal Membrane Oxygenation for Covid-19 Does Not Pose Extra Risk to Transport Team. ASAIO J 2022; 68:163-167. [PMID: 34802012 PMCID: PMC8796825 DOI: 10.1097/mat.0000000000001602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Previous experience has shown that transporting patients on extracorporeal membrane oxygenation (ECMO) is a safe and effective mode of transferring critically ill patients requiring maximum mechanical ventilator support to a quaternary care center. The coronavirus disease 2019 (COVID-19) pandemic posed new challenges. This is a multicenter, retrospective study of 113 patients with confirmed severe acute respiratory syndrome coronavirus 2, cannulated at an outside hospital and transported on ECMO to an ECMO center. This was performed by a multidisciplinary mobile ECMO team consisting of physicians for cannulation, critical care nurses, and an ECMO specialist or perfusionist, along with a driver or pilot. Teams practised strict airborne contact precautions with eyewear while caring for the patient and were in standard Personal Protective Equipment. The primary mode of transportation was ground. Ten patients were transported by air. The average distance traveled was 40 miles (SD ±56). The average duration of transport was 133 minutes (SD ±92). When stratified by mode of transport, the average distance traveled for ground transports was 36 miles (SD ±52) and duration was 136 minutes (SD ±93). For air, the average distance traveled was 66 miles (SD ±82) and duration was 104 minutes (SD ±70). There were no instances of transport-related adverse events including pump failures, cannulation complications at outside hospital, or accidental decannulations or dislodgements in transit. There were no instances of the transport team members contracting COVID-19 infection within 21 days after transport. By adhering to best practices and ACE precautions, patients with COVID-19 can be safely cannulated at an outside hospital and transported to a quaternary care center without increased risk to the transport team.
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Affiliation(s)
- Jeffrey Javidfar
- From the Department of Surgery, Emory School of Medicine, Atlanta, Georgia
| | | | | | | | - Maria Callahan
- From the Department of Surgery, Emory School of Medicine, Atlanta, Georgia
| | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | | | | | - José Binongo
- Rollins School of Public Health Emory University, Atlanta, Georgia
| | - Jane Wenjing Wei
- Congenital Heart Center, Department of Surgery, University of Florida, Gainesville, Florida
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Giles Peek
- Congenital Heart Center, Department of Surgery, University of Florida, Gainesville, Florida
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Hadaya J, Sanaiha Y, Gudzenko V, Qadir N, Singh S, Nsair A, Cho NY, Shemin RJ, Benharash P. Implementation and Outcomes of an Urban Mobile Adult Extracorporeal Life Support Program. JTCVS Tech 2022; 12:78-92. [PMID: 35403027 PMCID: PMC8987336 DOI: 10.1016/j.xjtc.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective Methods Results Conclusions
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Pediatric Extracorporeal Membrane Oxygenation Reach-Out Program: Successes and Insights. ASAIO J 2021; 66:1036-1041. [PMID: 31977355 DOI: 10.1097/mat.0000000000001110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The shortage of dedicated pediatric extracorporeal membrane oxygenation (ECMO) centers and the expanding indications for pediatric ECMO necessitate a regional program for transport of ECMO-supported patients. Data about feasibly and safety of pediatric ECMO transport are scarce. Our aim is to describe our experience with a pediatric ECMO reach-out program and review pertinent literature. Demographic, clinical, and outcome data were collected retrospectively from the charts of all patients cannulated onto ECMO at referring centers and transported to our center from 2003 to 2018. Similar data were recorded for patients who were referred for ECMO support from within the hospital. The cohort included 80 patients cannulated at 17 referring centers. The transport team included a senior pediatric cardiac surgeon and an ECMO specialist. All transfers but one were done by special emergency medical service ambulance. No major complications or deaths occurred during transport, and all patients were stable upon arrival to our unit. Mortality was lower in the ECMO reach-out cohort than in-house patients referred for ECMO support. This is the first study from Israel and one of the largest to date describing a dedicated pediatric ECMO transport program. Extracorporeal membrane oxygenation transport appears to be feasible and safe when conducted by a small, highly skilled mobile team. Successful reach-out program requires open communication between the referring physician and the accepting center. As survival correlates with ECMO volume, maintaining a large ECMO center with 24/7 retrieval capabilities may be the best strategy for pediatric mechanical circulatory support program.
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6
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Heart Transplantation in a Distant Island Population: Accessibility and Outcomes in Patients From the Canary Islands Transplanted in Madrid. Transplantation 2020; 104:223-226. [PMID: 32000231 DOI: 10.1097/tp.0000000000002929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Lazzeri C, Cianchi G, Mauri T, Pesenti A, Bonizzoli M, Batacchi S, Chiostri M, Socci F, Peris A. A novel risk score for severe ARDS patients undergoing ECMO after retrieval from peripheral hospitals. Acta Anaesthesiol Scand 2018; 62:38-48. [PMID: 29058310 DOI: 10.1111/aas.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/10/2017] [Accepted: 10/04/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Extracorporeal Membrane Oxygenation in severe ARDS unresponsive to conventional protective ventilation is associated with elevated costs, resource and complications, and appropriate risk stratification of candidate patients could be useful to recognize those more likely to benefit from ECMO. We aimed to derive a new outcome prediction score for patients retrieved by our ECMO team from peripheral centers, including systematic echocardiographic evaluation before ECMO start. METHODS Sixty-nine consecutive patients with refractory ARDS requiring ECMO transferred from peripheral centers to our ICU (a tertiary ECMO referral center), from 1 October 2009 to 31 December 2015, were assessed. RESULTS All patients were transported on ECMO (distance, median 77, range 4-456 km) The mortality rate was 41% (28/69). Our new risk score included age ≥ 42 years, BMI < 31 kg/m2 , RV dilatation, and pH < 7.35. The proposed cut off (Youden's index method) of nine had a sensitivity of 96% and a specificity of 30% (AUC-ROC: 0.85, 95% CI: 0.76-0.94, P < 0.001). When assessing the discriminatory ability of our risk score in the population of local patients, survivors had a mean value of 15.4 ± 8.6, whereas non-survivors showed a mean value of 20.1 ± 7.4 (P < 0.001). CONCLUSIONS Our new risk score shows good discriminatory ability both in patients retrieved from peripheral centers and in those implanted at our center. This score includes variables easily available at bedside, and, for the first time, a pathophysiologic element, RV dilatation.
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Affiliation(s)
- C. Lazzeri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - G. Cianchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - T. Mauri
- Department of Anesthesia, Critical Care and Emergency; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - A. Pesenti
- Department of Anesthesia, Critical Care and Emergency; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - M. Bonizzoli
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - S. Batacchi
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - M. Chiostri
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - F. Socci
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
| | - A. Peris
- Intensive Care Unit and Regional ECMO Referral centre; Azienda Ospedaliero-Universitaria Careggi; Florence Italy
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8
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Burrell AJC, Pilcher DV, Pellegrino VA, Bernard SA. Retrieval of Adult Patients on Extracorporeal Membrane Oxygenation by an Intensive Care Physician Model. Artif Organs 2017; 42:254-262. [PMID: 29152759 DOI: 10.1111/aor.13010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/10/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
The optimal staffing model during the inter-hospital transfer of patients on extracorporeal membrane oxygenation (ECMO) is not known. We report the complications and outcomes of patients who were commenced on ECMO at a referring hospital by intensive care physicians and compare these findings with patients who had ECMO established at an ECMO center in Australia. This was a single center, retrospective observational study based on a prospectively collected ECMO database from Melbourne, Australia. Patients with severe cardiac and/or respiratory failure failing conventional supportive treatment between 2007-2013 were placed on ECMO via a physician-led model of ECMO retrieval, including two intensivists in a four person team, using percutaneous ECMO cannulation. Patients (198) underwent ECMO over the study period, of which 31% were retrieved. Veno-venous (VV)-ECMO and veno-arterial (VA)-ECMO accounted for 27 and 73% respectively. The VA-ECMO patients had more intra-transport interventions compared with VV-ECMO transported patients, but none resulting in serious morbidity or death. There was no overall difference in survival at 6 months between retrieved and ECMO center patients: VV-ECMO (75 vs. 70%, P = 0.690) versus VA-ECMO (70 vs. 68%, P = 1.000). An intensive care physician-led team was able to safely place all critically ill patients on ECMO and retrieve them to an ECMO center. This may be an appropriate staffing model for ECMO retrieval.
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Affiliation(s)
- Aidan J C Burrell
- The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - David V Pilcher
- The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Vincent A Pellegrino
- The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Stephen A Bernard
- The Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health, Monash University, Melbourne, Victoria, Australia
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9
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Extracorporeal Membrane Oxygenation and Interfacility Transfer: A Regional Referral Experience. Ann Thorac Surg 2017; 104:1471-1478. [DOI: 10.1016/j.athoracsur.2017.04.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/26/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022]
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10
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Hong TH, Lee H, Jung JJ, Cho YH, Sung K, Yang JH, Lee YT, Cho SH. Inter-Facility Transport on Extracorporeal Life Support: Clinical Outcomes and Comparative Analysis with In-house Patients. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:363-370. [PMID: 29124028 PMCID: PMC5628964 DOI: 10.5090/kjtcs.2017.50.5.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/16/2017] [Accepted: 05/09/2017] [Indexed: 11/16/2022]
Abstract
Background Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. Methods This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients. We also analyzed the risk factors for hospital mortality in the entire ECLS population using univariate and multivariate analyses to investigate the effects of transport. Results All 44 patients were safely transported without adverse events. The average travel distance was 178.7 km, with an average travel time of 74.0 minutes. Early survival of the transported group seemed to be better than that of the in-house group, but the difference was not statistically significant (70.5% vs. 56.6%, p=0.096). The incidence of complications was similar between the 2 groups, except for critical limb ischemia, which was significantly more common in the transported group than in the in-house group (25.0% vs. 8.1%, p=0.017). After adjusting for confounders, being part of the transported group was not a predictor of early death (adjusted odds ratio, 0.689; p=0.397). Conclusion Transportation of patients on ECLS is relatively safe, and the clinical outcomes of transported patients are comparable to those of in-house ECLS patients. Although matched studies are required, our study demonstrates that transporting patients on ECLS did not increase their risk of hospital mortality after adjustment for other factors.
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Affiliation(s)
- Tae Hee Hong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jae Jun Jung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young-Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Su Hyun Cho
- Extracorporeal Perfusion Team, Samsung Medical Center, Sungkyunkwan University School of Medicine
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11
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Broman LM. Inter-hospital transports on extracorporeal membrane oxygenation in different health-care systems. J Thorac Dis 2017; 9:3425-3429. [PMID: 29221329 DOI: 10.21037/jtd.2017.07.93] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The feasibility and the recognition of the possibility to transport patients on extracorporeal membrane oxygenation (ECMO) aroused in the 1970s. The number of transporting facilities worldwide was less than 20 in the beginning of the second Millennium. In 2009 the H1N1 pandemic and a publication showing survival benefit for adult patients transported to a hospital with ECMO resource increased both awareness and interest for ECMO treatment. The number of transport organizations increased rapidly. As of today, the number of transport organizations increases world-wide, though some centers where ECMO is an established treatment report decreasing numbers of transports. Since the introduction of the more user-friendly equipment (ECMO-2 era) increasing numbers of low-volume ECMO centers perform these complex treatments. This overview is based on the current literature, personal experience in the field, and information from the authors' network on the organization of ECMO transport systems in different settings of health care around the globe. Registry data since the entry into ECMO-2 shows that the number of ECMO treatments matter. The more treatments performed at a given center the better the patient outcome, and the better these resources are spent for the population served. A Hub-and-Spoke model for national or regional organization for respiratory ECMO (rECMO) should be advocated where central high-volume ECMO center (Hub) serves a population of 10 to 15 million. Peripheral units (Spokes) play an important part in emergency cannulations keeping the patient on ECMO support till a mobile ECMO team retrieves the patient. This ECMO team is preferably organized from the Hub and brings competencies for assessment and decision to initiate ECMO treatment bedside at any hospital, for cannulation, and a safe transport to any destination. To conclude, most ECMO transport organizations are reflections of the health care paradigm within which they act. Most transport organizations are established by the staff within who recognize the need. The legal space seems open in most countries; anyone may set up a transport organization anywhere. Quality follow-up varies. Some keep track of adverse events and report whereas most transport entities do not seem to prioritize this. There is no international body for ECMO transports. Such would be the key for definitions, support, networking, and a registry that successively would increase knowledge concerning adverse events, morbidity and mortality.
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Affiliation(s)
- Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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12
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Guenther SPW, Buchholz S, Born F, Brunner S, Schramm R, Hoechter DJ, von Dossow V, Pichlmaier M, Hagl C, Khaladj N. Remote ECLS-Implantation and Transport for Retrieval of Cardiogenic Shock Patients. Air Med J 2017; 36:320-326. [PMID: 29132595 DOI: 10.1016/j.amj.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Sabina P W Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany.
| | - Stefan Buchholz
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Stefan Brunner
- Medical Department I (Cardiology), University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - René Schramm
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Dominik J Hoechter
- Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Vera von Dossow
- Department of Anesthesiology, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Maximilian Pichlmaier
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Nawid Khaladj
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Marchioninistr. 15, 81377 Munich, Germany
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13
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Huang L, Li T, Xu L, Hu XM, Duan DW, Li ZB, Gao XJ, Li J, Wu P, Liu YW. Extracorporeal Membrane Oxygenation Outcomes in Acute Respiratory Distress Treatment: Case Study in a Chinese Referral Center. Med Sci Monit 2017; 23:741-750. [PMID: 28184033 PMCID: PMC5317293 DOI: 10.12659/msm.900005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background No definitive conclusions have been drawn from the available data about the utilization of extracorporeal membrane oxygenation (ECMO) to treat severe acute respiratory distress syndrome (ARDS). The aim of this study was to review our center’s experience with ECMO and determine predictors of outcome from our Chinese center. Material/Methods We retrospectively analyzed a total of 23 consecutive candidates who fulfilled the study entry criteria between January 2009 and December 2015. Detailed clinical data, ECMO flow, and respiratory parameters before and after the introduction of ECMO were compared among in-hospital survivors and nonsurvivors; factors associated with mortality were investigated. Results Hemodynamics and oxygenation parameters were significantly improved after ECMO initiation. Thirteen patients survived to hospital discharge. Univariate correlation analysis demonstrated that APACHE II score (r=−0.463, p=0.03), acute kidney injury (r=−0.574, p=0.005), membrane oxygenator replacement (r=−0.516, p=0.014) and total length of hospital stay (r=0.526, p=0.012) were significantly correlated with survival to hospital discharge, and that the evolution of the levels of urea nitrogen, platelet, and fibrinogen may help to determine patient prognosis. Sixteen patients referred for ECMO from an outside hospital were successfully transported to our institution by ambulance, including seven transported under ECMO support. The survival rate of the ECMO-transport group was comparable to the conventional transport or the non-transport group (both p=1.000). Conclusions ECMO is an effective alternative option for severe ARDS. APACHE II score on admission, onset of acute kidney injury, and membrane oxygenator replacement, and the evolution of levels of urea nitrogen, platelet, and fibrinogen during hospitalization may help to determine the in-hospital patient prognosis. By establishing a well-trained mobile ECMO team, a long-distance, inter-hospital transport can be administered safely.
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Affiliation(s)
- Lei Huang
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
| | - Tong Li
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
| | - Lei Xu
- Department of Critical Care Medicine, Tianjin third central hospital, Tianjin, China (mainland)
| | - Xiao-Min Hu
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
| | - Da-Wei Duan
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
| | - Zhi-Bo Li
- Department of Critical Care Medicine, Tianjin third central hospital, Tianjin, China (mainland)
| | - Xin-Jing Gao
- Department of Critical Care Medicine, Tianjin third central hospital, Tianjin, China (mainland)
| | - Jun Li
- Department of Critical Care Medicine, Tianjin third central hospital, Tianjin, China (mainland)
| | - Peng Wu
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
| | - Ying-Wu Liu
- Department of Heart Center, Tianjin third central hospital, Tianjin, China (mainland)
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14
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Mendes PV, de Albuquerque Gallo C, Besen BAMP, Hirota AS, de Oliveira Nardi R, Dos Santos EV, Li HY, Joelsons D, Costa ELV, Foronda FK, Azevedo LCP, Park M. Transportation of patients on extracorporeal membrane oxygenation: a tertiary medical center experience and systematic review of the literature. Ann Intensive Care 2017; 7:14. [PMID: 28176223 PMCID: PMC5296266 DOI: 10.1186/s13613-016-0232-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/25/2016] [Indexed: 12/29/2022] Open
Abstract
Background Utilization of extracorporeal membrane oxygenation (ECMO) has increased worldwide, but its use remains restricted to severely ill patients, and few referral centers are properly structured to offer this support. Inter-hospital transfer of patients on ECMO support can be life-threatening. In this study, we report a single-center experience and a systematic review of the available published data on complications and mortality associated with ECMO transportation. Methods We reported single-center data regarding complications and mortality associated with the transportation of patients on ECMO support. Additionally, we searched multiple databases for case series, observational studies, and randomized controlled trials regarding mortality of patients transferred on ECMO support. Results were analyzed independently for pediatric (under 12 years old) and adult populations. We pooled mortality rates using a random-effects model. Complications and transportation data were also described. Results A total of 38 manuscripts, including our series, were included in the final analysis, totaling 1481 patients transported on ECMO support. A total of 951 patients survived to hospital discharge. The pooled survival rates for adult and pediatric patients were 62% (95% CI 57–68) and 68% (95% CI 60–75), respectively. Two deaths occurred during patient transportation. No other complication resulting in adverse outcome was reported. Conclusion Using the available pooled data, we found that patient transfer to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0232-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pedro Vitale Mendes
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil. .,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | | | | | | | - Ho Yeh Li
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Daniel Joelsons
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Eduardo Leite Vieira Costa
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Luciano Cesar Pontes Azevedo
- Intensive Care Unit, Hospital das Clinicas, University of São Paulo School of Medicine, Rua Dr. Enéas Carvalho de Aguiar, 255, Sala 5023, São Paulo, SP, 05403000, Brazil.,Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Marcelo Park
- Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil
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15
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Grenda DS, Moll V, Kalin CM, Blum JM. Remote cannulation and extracorporeal membrane oxygenation transport is safe in a newly established program. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:71. [PMID: 28275616 DOI: 10.21037/atm.2016.11.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has become an increasingly utilized modality for the support of patients with severe cardiac or pulmonary dysfunction. Unfortunately, the costs and expertise required to maintain a formal ECMO program preclude the vast majority of hospitals from employing such technology routinely. These barriers to implementation of an effective ECMO program highlight the importance of the safe transport of patients in need of extracorporeal support. While many centers with extensive expertise in the management of patients on extracorporeal support have demonstrated their ability to transport those same patients, the ability of new ECMO programs to provide such transportation remains poorly studied. We established an ECMO program at our institution and immediately provided equipment and personnel to transport patients in need of or receiving extracorporeal support to our institution. Overall, we found that 13 out of 28 patients transported to our institution on ECMO or for consideration of ECMO support during the first 15 months of the program survived to hospital discharge. During that period, four incidents associated with patient transport occurred but none were related to ECMO support or adversely affected patient outcome. These observations demonstrate that new ECMO programs can safely and reliably transport patients on or in need of extracorporeal support.
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Affiliation(s)
- David S Grenda
- Department of Anesthesiology, Division of Critical Care Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Vanessa Moll
- Department of Anesthesiology, Division of Critical Care Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Craig M Kalin
- Department of Perfusion, Emory University Hospital, Atlanta, Georgia, USA
| | - James M Blum
- Department of Anesthesiology, Division of Critical Care Medicine, Emory University Hospital, Atlanta, Georgia, USA
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16
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Outcome Comparison in Children Undergoing Extracorporeal Life Support Initiated at a Local Hospital by a Mobile Cardiorespiratory Assistance Unit or at a Referral Center. Pediatr Crit Care Med 2016; 17:992-997. [PMID: 27705983 DOI: 10.1097/pcc.0000000000000897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare characteristics and outcome in children undergoing extracorporeal life support initiated in an extracorporeal life support center or at the patient's bedside in a local hospital, by means of a mobile cardiorespiratory assistance unit. METHODS A retrospective study in a single PICU during 6 years. Extracorporeal life support was started either in our center (control group) or in the local hospital (mobile cardiorespiratory assistance unit group). The data collected were demographics, markers of patient's preextracorporeal life support condition, and outcome. RESULTS One hundred twenty-six children underwent extracorporeal life support, 105 in the control group and 21 in the mobile cardiorespiratory assistance unit group. There was no difference between groups in terms of age, weight, or Pediatric Risk of Mortality II score. There was a significant difference in organ failure etiology between groups, with more respiratory cases in the mobile cardiorespiratory assistance unit group (76.2%) and more cardiac surgery cases in the control group (60%; p < 0.001). The duration of extracorporeal life support was longer in the mobile cardiorespiratory assistance unit group than in the control group (10 [1-36] vs 5 [0-33] d; p = 0.003). PICU length of stay and mortality (60% vs 47.6%; p = 0.294) were not significantly different between the two groups. To allow comparison of a more homogenous population, a subgroup analysis was performed including only respiratory failure patients from the two groups (R-control group [n = 22] and R-mobile cardiorespiratory assistance unit group [n = 16]). PICU length of stay was 17 (3-64) days in the R-control group and 23 (1-45) days in the R-mobile cardiorespiratory assistance unit group (p = 0.564), and PICU mortality rate was 54.5% in the R-control group and 43.8% in the R-mobile cardiorespiratory assistance unit group (p = 0.511). There was no difference between the R-groups for age, weight, Pediatric Risk of Mortality II score, and markers of kidney or liver dysfunction, and lactate blood levels. CONCLUSION Extracorporeal life support can be safely initiated at children's bedside in the local hospital and then transported to the specialized referral center. Our results support the validity of an interregional organization of mobile cardiorespiratory assistance unit teams.
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17
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Spratt JR, Raveendran G, Liao K, John R. Novel percutaneous mechanical circulatory support devices and their expanding applications. Expert Rev Cardiovasc Ther 2016; 14:1133-50. [DOI: 10.1080/14779072.2016.1214573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Nwozuzu A, Fontes ML, Schonberger RB. Mobile Extracorporeal Membrane Oxygenation Teams: The North American Versus the European Experience. J Cardiothorac Vasc Anesth 2016; 30:1441-1448. [PMID: 27686513 DOI: 10.1053/j.jvca.2016.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate differences in the inclusion of anesthesiologists in mobile extracorporeal membrane oxygenation (ECMO) teams between North American and European centers. DESIGN A retrospective review of North American versus European mobile ECMO teams. The search terms used to identify relevant articles were the following: "extracorporeal membrane transport," "mobile ECMO," and "interhospital transport." SETTING MEDLINE review of articles. PARTICIPANTS None. INTERVENTIONS None. RESULTS Between 1986 and 2015, 25 articles were published that reported the personnel makeup of mobile ECMO teams in North America and Europe: 6 from North American centers and 19 from European centers. The included articles reported a total of 1,329 cases: 389 (29%) adult-only cohorts and 940 (71%) mixed-age cohorts. Among North American studies, 0 of 6 (0%) reported the presence of an anesthesiologist on the mobile ECMO team in contrast to European studies, in which 10 of 19 (53%) reported the inclusion of an anesthesiologist (Fisher exact p for difference = 0.05). In terms of number of cases, this discrepancy translated to 543 total cases in North America (all without an anesthesiologist) and 499 cases in Europe (37%) including an anesthesiologist on the team (Fisher exact p for difference<0.001). CONCLUSIONS This study demonstrated significant geographic discrepancies in the inclusion of anesthesiologists on mobile ECMO teams, with European centers more likely to incorporate an anesthesiologist into the mobile ECMO process compared with North American centers.
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Affiliation(s)
- Adambeke Nwozuzu
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - Manuel L Fontes
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
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Moll V, Teo EY, Grenda DS, Powell CD, Connor MJ, Gartland BT, Zellinger MJ, Bray HB, Paciullo CA, Kalin CM, Wheeler JM, Nguyen DQ, Blum JM. Rapid Development and Implementation of an ECMO Program. ASAIO J 2016; 62:354-8. [PMID: 26735556 PMCID: PMC4867977 DOI: 10.1097/mat.0000000000000331] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an established therapy in the management of patients with refractory cardiogenic shock or acute respiratory failure. In this report, we describe the rapid development and implementation of an organized ECMO program at a facility that previously provided ad hoc support. The program provides care for patients within the Emory Healthcare system and throughout the Southeastern United States. From September 2014 to February 2015, 16 patients were treated with either venovenous or venoarterial ECMO with a survival to decannulation of 53.3% and survival to intensive care unit discharge of 40%. Of the 16 patients, 10 were transfers from outside facilities of which 2 were remotely cannulated and initiated on ECMO support by our ECMO transport team. Complications included intracerebral hemorrhage, bleeding from other sites, and limb ischemia. The results suggest that a rapidly developed ECMO program can provide safe transport services and provide outcomes similar to those in the existing literature. Key components appear to be an institutional commitment, a physician champion, multidisciplinary leadership, and organized training. Further study is required to determine whether outcomes will continue to improve.
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Affiliation(s)
- Vanessa Moll
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Elrond Y.L. Teo
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - David S. Grenda
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Cindy D. Powell
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Michael J. Connor
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bryce T. Gartland
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Mary J. Zellinger
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - H. Bruce Bray
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Christopher A. Paciullo
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Craig M. Kalin
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jean M. Wheeler
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Duc Q. Nguyen
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - James M. Blum
- From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; Department of Medicine, Divisions of Pulmonary, Allergy, Sleep and Critical Care and Renal Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia; Division of Cardiovascular Nursing, Emory University School of Medicine, Atlanta, Georgia; Department of Respiratory Care, ECMO Service, Neurophysiology, EKG, Pulmonary Function and Blood Gas Laboratories, Emory University Hospital, Emory University Orthopaedics and Spine Hospital, Atlanta, Georgia; Department of Pharmacy, Emory University Hospital, Atlanta, Georgia; Department of Perfusion, Emory University Hospital, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
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Maillot A, Bussienne F, Braunberger E, Bouchet B, Martinet O, Nativel F, Combes X. Long-distance air transfer on commercial long-haul flights for patients on extracorporeal life support. Intensive Care Med 2016; 42:949-950. [DOI: 10.1007/s00134-016-4272-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2016] [Indexed: 11/24/2022]
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21
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Biscotti M, Agerstrand C, Abrams D, Ginsburg M, Sonett J, Mongero L, Takayama H, Brodie D, Bacchetta M. One Hundred Transports on Extracorporeal Support to an Extracorporeal Membrane Oxygenation Center. Ann Thorac Surg 2015; 100:34-9; discussion 39-40. [PMID: 25912741 DOI: 10.1016/j.athoracsur.2015.02.037] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/27/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Extracorporeal life support technology has gained acceptance as a salvage mode for patients in respiratory or cardiac failure. Patients who are sick enough to require extracorporeal membrane oxygenation (ECMO) support are often too unstable for transfer to a hospital with ECMO capabilities. We highlight the progressive development of an ECMO transport team and the manner in which it provides reliable transport with excellent outcomes. METHODS All data were collected retrospectively from our hospital's electronic medical record. Patient outcomes are reported through April 2, 2014. RESULTS Our institution began an ECMO transport program in 2008, with the initial phase involving transport of highly selected patients for short distances. With experience we refined our intake and evaluation process. We also consolidated care for ECMO patients into two intensive care units and developed a dedicated ECMO intensivist position. As the program has matured, patient selection has become more inclusive and we have extended our capabilities to include interstate and international transport. All 100 patients were successfully placed on ECMO and transported to our center. Seventy-nine patients were placed on venovenous ECMO, 19 on venoarterial ECMO, and 2 on venovenous arterial ECMO. The median transport distance was 16 miles and ranged from 2.5 to 7,084 miles. CONCLUSIONS Extracorporeal membrane oxygenation transport can be performed safely and reliably with excellent outcomes with a dedicated team that maintains stringent adherence to well-designed management protocols.
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Affiliation(s)
- Mauer Biscotti
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Cara Agerstrand
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mark Ginsburg
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Joshua Sonett
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | | | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Matthew Bacchetta
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
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VEIEN M, LINDBERG L, TYNKKYNEN P, RAVN HB. Paediatric ECMO at low-volume paediatric cardiac centres in the Nordic countries. Acta Anaesthesiol Scand 2015; 59:337-45. [PMID: 25582418 DOI: 10.1111/aas.12460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a life-saving resource-intensive technology for patients with respiratory and/or circulatory failure. We aimed to evaluate outcome data from three Nordic paediatric centres comparing with data from the International Registry of the Extracorporeal Life Support Organization (ELSO) and selected high-volume single-centre studies. METHODS One-hundred nineteen patients < 19 years from 2002 to 2012 were enrolled. Data on demographics and outcome were collected using a standardised registration form. Outcome data were compared with the ELSO registry and high-volume single-centre studies. RESULTS Demographics, indications and diagnosis were similar to the ELSO register. Survival after ECMO was similar to outcome data from the ELSO register, apart from paediatric cardiac ECMO, where a significantly better survival to discharge was seen in the Nordic centres (68% vs. 49%; P = 0.03). Comparison with high-volume centres in the period after 2005 demonstrated a significantly better survival after cardiac ECMO in a single high-volume centre study, whereas four studies had significantly lower survival after cardiac ECMO. No significant difference was seen in children receiving respiratory ECMO in the Nordic centres and high-volume centres. CONCLUSIONS Survival after ECMO in three low-volume Nordic centres demonstrated comparable outcome data with ELSO data and data from high-volume centres. We believe regular quality assurance surveys, as the present study, should be performed in order to maintain excellent therapy within the individual ECMO centres.
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Affiliation(s)
- M. VEIEN
- Department of Anaesthesia and Intensive Care; University Hospital of Aarhus; Aarhus N Denmark
| | - L. LINDBERG
- Department of Clinical Sciences; Skane University Hospital of Lund; Lund Sweden
| | - P. TYNKKYNEN
- Department of Anaesthesiology and Intensive Care; University Hospital of Helsinki; Helsinki Finland
| | - H. B. RAVN
- Department of Anaesthesia and Intensive Care; University Hospital of Aarhus; Aarhus N Denmark
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Shankar V, Costello JP, Peer SM, Klugman D, Nath DS. Ethical dilemma: offering short-term extracorporeal membrane oxygenation support for terminally ill children who are not candidates for long-term mechanical circulatory support or heart transplantation. World J Pediatr Congenit Heart Surg 2015; 5:311-4. [PMID: 24668981 DOI: 10.1177/2150135113509820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in terminally ill pediatric patients who are not candidates for long-term mechanical circulatory support or heart transplantation requires careful deliberation. We present the case of a 16-year-old female with a relapse of acute lymphoid leukemia and acute-on-chronic cardiomyopathy who received short-term ECMO therapy. In addition, we highlight several ethical considerations that were crucial to this patient's family-centered care and demonstrate that this therapy can be accomplished in a manner that respects patient autonomy and family wishes.
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Affiliation(s)
- Venkat Shankar
- Department of Critical Care Medicine, Children's National Medical Center, Washington, DC, USA
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Bryner B, Cooley E, Copenhaver W, Brierley K, Teman N, Landis D, Rycus P, Hemmila M, Napolitano LM, Haft J, Park PK, Bartlett RH. Two Decades’ Experience With Interfacility Transport on Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2014; 98:1363-70. [DOI: 10.1016/j.athoracsur.2014.06.025] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 11/25/2022]
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Delnoij TSR, Veldhuijzen G, Strauch U, Van Mook WNKA, Bergmans DCJJ, Bouman EA, Lance MD, Smets M, Breedveld P, Ganushchak YM, Weerwind P, Kats S, Roekaerts PM, Maessen J, Donker DW. Mobile respiratory rescue support by off-centre initiation of extracorporeal membrane oxygenation. Perfusion 2014; 30:255-9. [PMID: 24965912 DOI: 10.1177/0267659114540735] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T S R Delnoij
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G Veldhuijzen
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - U Strauch
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - W N K A Van Mook
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D C J J Bergmans
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E A Bouman
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M D Lance
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Anaesthesiology and Pain Treatment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Smets
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Breedveld
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Y M Ganushchak
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Weerwind
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P M Roekaerts
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D W Donker
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Unités mobiles d’assistance circulatoire. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-014-0877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure: an evidence-based review of the past decade (2002-2012). Pediatr Crit Care Med 2013; 14:851-61. [PMID: 24108118 DOI: 10.1097/pcc.0b013e3182a5540d] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide a comprehensive evidence-based review of extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure. DATA SOURCE A thorough computerized bibliographic search of the clinical literature regarding the use of extracorporeal membrane oxygenation in the neonatal and pediatric populations. STUDY SELECTION Clinical trials published between January 1, 2002, and October 1, 2012, including "extracorporeal membrane oxygenation" or "ECMO" and limited to studies involving humans aged 0-18 years. Trials focused on extracorporeal membrane oxygenation for cardiac indications were excluded from this study, unless the study was evaluating ancillary therapies in conjunction with extracorporeal membrane oxygenation. DATA EXTRACTION Studies were evaluated for inclusion based on reporting of patient outcomes and/or strategic considerations, such as cannulation strategies, timing of extracorporeal membrane oxygenation utilization, and ancillary therapies. DATA SYNTHESIS Pertinent data are summarized, and the available data are objectively classified based on the value of the study design from which the data are obtained. CONCLUSIONS Despite a large number of published extracorporeal membrane oxygenation studies, there remains a paucity of high-quality clinical trials. The available data support continued use of extracorporeal membrane oxygenation for respiratory failure refractory to conventional therapy for neonatal and pediatric patients without significant comorbidities. Further research is needed to better quantify the benefit of extracorporeal membrane oxygenation and the utility of many therapies commonly applied to extracorporeal membrane oxygenation patients.
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Lunz D, Philipp A, Judemann K, Amann M, Foltan M, Schmid C, Graf B, Zausig YA. First experience with the deltastream(R) DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-hospital transport. Interact Cardiovasc Thorac Surg 2013; 17:773-7. [PMID: 23873380 DOI: 10.1093/icvts/ivt320] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Based on continuous technical innovations and recent research, extracorporeal membrane oxygenation (ECMO) has become a promising tool in the treatment of patients with acute (cardio)pulmonary failure. Nevertheless, any extracorporeal technique requires a high degree of experience and knowledge, so that a restriction to specialized centres seems to be reasonable. As a consequence of this demand, the need for inter-hospital transfer of patients with severely impaired (cardio)pulmonary function is rising. Unfortunately, most of the ECMO devices used in the clinical setting are not suitable for inter-hospital transport because of their size, weight or complexity. In this article, we describe our first experiences with the airborne transport of 6 patients on a new portable, miniaturized and lightweight extracorporeal circulation system, the Medos deltastream® DP3. METHODS Six patients suffering acute respiratory failure were taken on venovenous ECMO (DP3) out-of-centre and transferred to the University Medical Center Regensburg by helicopter. All cardiorespiratory-relevant parameters of the patients and the technical functioning of the device were continuously monitored and documented. RESULTS Implantation of the device and air-supported transport were performed without any technical complications. The patients were transported from a distance of 66-178 km, requiring a time of 40-120 min. With the help of the new deltastream® DP3 ECMO device, a prompt stabilization of the cardiopulmonary function could be achieved in all patients. One patient was under ongoing cardiopulmonary resuscitation by the time our ECMO team arrived at the peripheral hospital and died shortly after arrival in the central emergency ward. CONCLUSIONS Our experience shows that the deltastream® DP3 is an absolutely reliable and safe ECMO device that could gain growing importance in the field of airborne transportation of patients on ECMO due to its unsophisticated, miniaturized and lightweight characteristics.
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Affiliation(s)
- Dirk Lunz
- Department of Anesthesiology, University Medical Center, Regensburg, Germany
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Lebreton G, Sanchez B, Hennequin JL, Resière D, Hommel D, Léonard C, Mehdaoui H, Roques F. The French airbridge for circulatory support in the Carribean. Interact Cardiovasc Thorac Surg 2012; 15:420-5. [PMID: 22659268 DOI: 10.1093/icvts/ivs215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES We report the assessment and the activities for the first year of our airborne circulatory support mobile unit (CSMU) in the French Caribbean. METHODS From January 2010 to June 2011, 12 patients (mean age = 35.7 years; range: 15-62 years; sex ratio = 1:1) were attended outside Martinique by our CSMU and transferred to our unit by air. RESULTS Eight patients had acute respiratory distress syndrome and were assisted by veno-venous extra corporeal membrane oxygenation (ECMO) four had refractory cardiogenic shock, assisted by extra corporeal life support (ECLS). The average air transfer distance for patients was 912 km (range: 198-1585 km). The average flying time was 124 min (range: 45-255 min). The aircraft used were helicopter, military transport or private jet. The setting-up of assistance devices and transfer of patients was uneventful. One patient subsequently benefited from heart transplantation after long-term circulatory support. One patient died under ECMO support after 51 days of assistance and another died on the 60th day after withdrawal of ECLS. CONCLUSIONS CSMUs can be very efficient in providing support to patients in refractory shock, when remote from a cardiac surgery centre. The airborne transfer of patients on ECMO/ECLS can be achieved safely, even over long distances.
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Affiliation(s)
- Guillaume Lebreton
- Department of Cardio-Thoracic Surgery, Fort-de-France University Hospital, Martinique, France.
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Extracorporeal membrane oxygenation for interhospital transfer of severe acute respiratory distress syndrome patients: 5-year experience. Int J Artif Organs 2012; 34:1052-60. [PMID: 22183518 DOI: 10.5301/ijao.5000011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE Transfer of severely hypoxic patients is a high-risk procedure. Extracorporeal membrane oxygenation (ECMO) allows safe transport of these patients to tertiary care institutions. Our ECMO transportation program was instituted in 2004; here we report results after 5 years of activity. METHODS This is a clinical observational study. Criteria for ECMO center activation were: potentially reversibile respiratory failure, PaO₂ <50 mmHg with FiO₂ >0.6 for >12 hours, PEEP >5 cmH₂0, Lung Injury Score (LIS) ≥3 or respiratory acidosis with pH <7.2, no intracranial bleeding, and no absolute contraindication to anticoagulation. If eligible, a skilled crew applied ECMO at the referral hospital. Transportation was performed with a specially equipped ambulance. RESULTS Sixteen patients were possible candidates for ECMO transfer. Two patients were excluded while 14 (mean±SD, age 35.4±18.6, SOFA 8.4±3.7, Oxygenation Index 43.7±13.4) were transported to our institution (distance covered 102±114 km, global duration of transport 589±186 minutes). Two patients improved after iNO-trial and were transferred and subsequently managed without ECMO. The remaining 12 patients were transferred on veno-venous ECMO with extracorporeal blood flow 2.7±1 L·min⁻¹, gas flow 3.8±1.8 L·min⁻¹, and FiO₂ 1. Data were recorded 30 minutes before and 60 minutes after initiation of ECMO. ECMO improved PCO₂ (75±23 vs. 53±9 mmHg, p<0.01) thus improving pH (7.28±0.13 vs. 7.39±0.05, p<0.01) and allowing a reduction in respiratory rate (35±14 vs. 10±4 breaths/min, p<0.01), minute ventilation (10.1±3.8 vs. 3.7±1.7 L·min⁻¹, p<0.01), and mean airway pressure (26±6.5 vs. 22±5 cmH₂O, p<0.01). No major clinical or technical complications were observed. CONCLUSIONS ECMO effectively enabled high-risk ground transfer of severely hypoxic patients.
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Forrest P, Cheong JY, Vallely MP, Torzillo PJ, Hendel PN, Wilson MK, Bannon PG, Bayfield MS, Herkes R, Walker SW. International Retrieval of Adults on Extracorporeal Membrane Oxygenation Support. Anaesth Intensive Care 2011; 39:1082-5. [DOI: 10.1177/0310057x1103900616] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrieval service was established in New South Wales to provide mobile extracorporeal membrane oxygenation support to patients with severe, acute cardiac or respiratory failure. This service has also retrieved four adult patients from Nouméa, New Caledonia to Sydney on extracorporeal membrane oxygenation support, which are the first international retrievals of this type from Australia. We discuss our experience with these patients, three of whom survived to hospital discharge. However, one patient referred from New Caledonia died before extracorporeal membrane oxygenation could be established.
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Affiliation(s)
- P. Forrest
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- University of Sydney
| | - J. Y. Cheong
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M. P. Vallely
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P. J. Torzillo
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P. N. Hendel
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M. K. Wilson
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P. G. Bannon
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Chair, Cardiothoracic Surgery, University of Sydney
| | - M. S. Bayfield
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - R. Herkes
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Intensive Care Department
| | - S. W. Walker
- Intensive Care Department
- Medical Director, Careflight International
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Surdey C. [MCAU/MRAU session: point of view of the pre-hospital Emergency Medical Services, costs assessment]. ACTA ACUST UNITED AC 2011; 30 Suppl 1:S30-2. [PMID: 21703484 DOI: 10.1016/s0750-7658(11)70007-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the 1970s, it has become possible to handle patients with serious pulmonary and cardiac failure with extracorporeal membrane oxygenation (ECMO) when conventional treatment fails, but only in specialized centers. When the latter were too far away, the risks of such transport were considered too high until the Mobile Cardiac Assistance Unit (MCAU) and Mobile Respiratory Assistance Unit (MRAU) were created. We are first going to expose the point of view of the pre-hospital Emergency Medical Services (EMS). The M.D. in need of such assistance should call the cardiac surgeon of the reference center : if the indication is confirmed, they will call the EMS (Service d'Aide Médicale Urgente, SAMU), and decide together which means is the most appropriate for a quick transportation of the team and the ECMO to the patient's bedside, and then back to the ECMO center, depending on the problems raised by ground vehicles on the one hand and aircrafts or helicopters on the other. Then, we are going to evaluate the cost of such transportation, which is quite considerable. As a conclusion, because of its high cost, the mobile inter-hospital ECMO. service should only be used when the patient is considered too ill to be transported on conventional therapy : in that case, this procedure represents huge progress.
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Affiliation(s)
- C Surdey
- Pôle d'Anesthésie-Réanimations-SAMU67/SMUR de Strasbourg, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg cedex, France.
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Safe Transport of Critically Ill Adult Patients on Extracorporeal Membrane Oxygenation Support to a Regional Extracorporeal Membrane Oxygenation Center. ASAIO J 2011; 57:421-5. [DOI: 10.1097/mat.0b013e3182238b55] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ciapetti M, Cianchi G, Zagli G, Greco C, Pasquini A, Spina R, Batacchi S, Bonizzoli M, Bonacchi M, Lazzeri C, Bernardo P, Peris A. Feasibility of inter-hospital transportation using extra-corporeal membrane oxygenation (ECMO) support of patients affected by severe swine-flu(H1N1)-related ARDS. Scand J Trauma Resusc Emerg Med 2011; 19:32. [PMID: 21619644 PMCID: PMC3117709 DOI: 10.1186/1757-7241-19-32] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/27/2011] [Indexed: 11/17/2022] Open
Abstract
Background To describe the organization of an ECMO-centre from triage by telephone to the phase of inter-hospital transportation with ECMO of patients affected by H1N1-induced ARDS, describing techniques and equipment used. Methods From September 2009 to January 2010, 18 patients with H1N1-induced ARDS were referred to our ECMO-centre from other hospitals. Six patients had contraindications to treatment with ECMO and remained in the local hospital. Twelve patients were transported to our centre and were included in this study. Four patients were transported on ECMO (Group A) and eight on conventional ventilation (Group B). The groups were compared on the basis of adverse events during transport, clinical characteristics and outcome. Results The PaO2/FiO2 ratio was lower in the patients of Group A (46.8 vs 89.7 [median]) despite the PEEP values being higher (15.0 vs 8.5 [median]). The Murray score was higher in Group A (3.50 vs 2.75 [median]). During the transfer there were no significant complications noted in Group A, whereas two patients in Group B were reported with hypoxia (SpO2 < 90%). One patient in Group A died. All the other patients of the two groups have been discharged from hospital. Conclusions The creation of an ECMO team, with various experts in the treatment of ARDS, assured a safe transfer of patients with severe hypoxia, over long distances, when in other cases they wouldn't have been be transportable.
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Affiliation(s)
- Marco Ciapetti
- Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy.
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Ecmo y ecmo mobile. soporte gardio respiratorio avanzado. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Retrieval of critically ill adults using extracorporeal membrane oxygenation: an Australian experience. Intensive Care Med 2011; 37:824-30. [PMID: 21359610 DOI: 10.1007/s00134-011-2158-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 10/30/2010] [Indexed: 01/21/2023]
Abstract
PURPOSE A retrieval program was developed in New South Wales (NSW), Australia to provide extracorporeal membrane oxygenation support (ECMO) for the safe transport of adults with severe, acute respiratory or cardiac failure. We describe the development and results of this program and the impact of the 2009 H1N1 epidemic on this service. METHODS An observational study of all patients who were retrieved on ECMO support in NSW, from March 1, 2007 to June 1, 2010, was carried out. RESULTS Forty adult patients were retrieved on ECMO support (median age 34 years). The indications for retrieval were respiratory in 38 patients (of whom 16 were confirmed or suspected H1N1 cases) and cardiac in 2 patients. Two other patients died after referral but before ECMO support could be established. Patients were transported by road (n = 26, 65%), medical retrieval jet (n = 10, 25%) and helicopter (n = 4, 10%). The median retrieval distance was 250 km (range 12-1,960 km). Thirty-four patients (85%) survived to hospital discharge. Survival for respiratory indications was 87% (33/38 patients) and 50% (1/2 patients) for cardiac indications. There were no deaths or major morbidity associated with these retrievals. CONCLUSIONS Patients with very severe respiratory failure, which was considered to preclude conventional ventilation for safe transfer to tertiary centres, were managed by an ECMO referral and retrieval program in NSW and had a high rate of survival. This program also enhanced the capacity of the state to respond to a surge in demand for ECMO support due to the H1N1 epidemic, although the role of ECMO in respiratory failure is not yet well defined.
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Cianchi G, Bonizzoli M, Pasquini A, Bonacchi M, Zagli G, Ciapetti M, Sani G, Batacchi S, Biondi S, Bernardo P, Lazzeri C, Giovannini V, Azzi A, Abbate R, Gensini G, Peris A. Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center. BMC Pulm Med 2011; 11:2. [PMID: 21223541 PMCID: PMC3022902 DOI: 10.1186/1471-2466-11-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 01/11/2011] [Indexed: 11/10/2022] Open
Abstract
Background Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance. Methods Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination. Results A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. Conclusions In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.
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Affiliation(s)
- Giovanni Cianchi
- Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy
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Cove ME, MacLaren G. Clinical review: mechanical circulatory support for cardiogenic shock complicating acute myocardial infarction. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:235. [PMID: 21067535 PMCID: PMC3219242 DOI: 10.1186/cc9229] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Acute myocardial infarction is one of the 10 leading reasons for admission to adult critical care units. In-hospital mortality for this condition has remained static in recent years, and this is related primarily to the development of cardiogenic shock. Recent advances in reperfusion therapies have had little impact on the mortality of cardiogenic shock. This may be attributable to the underutilization of life support technology that may assist or completely supplant the patient's own cardiac output until adequate myocardial recovery is established or long-term therapy can be initiated. Clinicians working in the intensive care environment are increasingly likely to be exposed to these technologies. The purpose of this review is to outline the various techniques of mechanical circulatory support and discuss the latest evidence for their use in cardiogenic shock complicating acute myocardial infarction.
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Affiliation(s)
- Matthew E Cove
- Cardiothoracic Intensive Care Unit, National University Health System, 5 Lower Kent Ridge Road, Singapore.
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