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Fiorelli F, Panoulas V, Riesgo Gil F, Era C, Rosenberg A. The challenge of advanced therapies in the contemporary era: first in Europe ECPELLA long-distance transfer-a case report. Eur Heart J Case Rep 2024; 8:ytae151. [PMID: 38751900 PMCID: PMC11095555 DOI: 10.1093/ehjcr/ytae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/12/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
Background The use of mechanical circulatory support (MCS) has markedly increased over the last decade, so have the inter-hospital transfers, with the aim of being able to offer advanced heart failure (AHF) therapies and centralizing patients to tertiary centres. Case summary In this article, we present the first in Europe long-distance air transfer of a patient supported by veno-arterial extracorporeal membrane oxygenator and Impella (ECPELLA), as a bridge to successful heart transplant. In our case report, a foreign young patient with AHF due to familiar cardiomyopathy required multiple MCS devices to achieve cardiovascular stability. After appropriate planning and multidisciplinary discussion, the patient was transferred on MCS to his country of origin via a fixed-wing airplane, in order to be assessed for heart transplantation. During take-off, the Impella flows temporarily dropped and a suction alarm was displayed; however, this rectified without intervention, and the rest of the flight was uneventful. One month after transfer, the patient underwent successful heart transplantation and remained clinically stable during the 12-month follow-up. Discussion Our experience links together the current challenges in the evolving AHF strategies and the increased need for inter-facility cooperation. Both these clinical and logistic challenges appear to lead to possible improved outcomes, after appropriate assessment, training, and accurate planning. Our experience provides useful information on feasibility of long-distance transport of patients supported by ECPELLA in Europe.
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Affiliation(s)
- Francesca Fiorelli
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK
| | - Fernando Riesgo Gil
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
| | - Carl Era
- Capital Air Ambulance, Bristol, BS48 3DP, UK
| | - Alexander Rosenberg
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Harefield Hospital, Hill End Road, Harefield, Uxbridge, UB9 6JH, UK
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Veyret S, Girard L, Puech B, Dangers L, Jabot J, Neuschwander A, Braunberger E, Allyn J, Allou N, Vidal C. The IMPACT Score: A New Score to Predict the Risk of Early Mortality in Cardiogenic Shock Patients Treated With Venoarterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth 2024; 38:451-458. [PMID: 38185567 DOI: 10.1053/j.jvca.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES Venoarterial extracorporeal membrane oxygenation (VA-ECMO) requires considerable human and financial resources. Few studies have focused on early mortality (ie, occurring within 72 hours after VA-ECMO implantation). The objective of this study was to establish a prognosis score-the IMPACT score (prediction of early mortality associated with VA-ECMO using preimplantation characteristics)-by determining the risk factors associated with early mortality. DESIGN This was a retrospective and observational study. SETTING The study was conducted at a University hospital. PARTICIPANTS This single-center retrospective study included 147 patients treated with VA-ECMO for cardiogenic shock between 2014 and 2021. METHODS The primary outcome was early mortality (ie, occurring within 72 hours after VA-ECMO implantation). Multivariate logistic regression was performed using a bootstrapping methodology to identify factors independently associated with early mortality. To construct the score, identified variables had points (pts) assigned corresponding to their odds ratio. RESULTS A total of 147 patients were included in the study. Early mortality (<72 hours) was 26% (38 patients). Four variables were established: cardiac arrest (2 pts), lactate levels (3 pts), platelet count <100 g/L (4 pts), and renal-replacement therapy (5 pts). The IMPACT score had an area under the receiver operating characteristic curve of 0.78 (95% CI 0.86-0.70) to predict early mortality. CONCLUSIONS In the authors' experience, 26% of patients treated with VA-ECMO presented early mortality. The IMPACT score is a reliable predictor of early mortality and may assist with VA-ECMO initiation decision-making.
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Affiliation(s)
- Simon Veyret
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Léandre Girard
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Bérénice Puech
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Laurence Dangers
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Julien Jabot
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Arthur Neuschwander
- Service de Réanimation de Chirurgie Cardio-thoracique et Vasculaire, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Eric Braunberger
- Service de Chirurgie Cardio-thoracique et Vasculaire, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Jérôme Allyn
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Nicolas Allou
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Charles Vidal
- Service de Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France.
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Berguigua H, Iche L, Roche P, Aubert C, Blondé R, Legrand A, Puech B, Combe C, Vidal C, Caron M, Jaffar-Bandjee MC, Caralp C, Oulehri N, Kerambrun H, Allyn J, Boué Y, Allou N. Emergency air evacuation of patients with acute respiratory failure due to SARS-CoV-2 from Mayotte to Reunion Island. Medicine (Baltimore) 2021; 100:e27881. [PMID: 35049190 PMCID: PMC9191376 DOI: 10.1097/md.0000000000027881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.
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Affiliation(s)
- Hamza Berguigua
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Ludovic Iche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Philippe Roche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Cyril Aubert
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Renaud Blondé
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Antoine Legrand
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Bérénice Puech
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Chloé Combe
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Charles Vidal
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Margot Caron
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | | | - Christophe Caralp
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nora Oulehri
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Hugo Kerambrun
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Jérôme Allyn
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Yvonnick Boué
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nicolas Allou
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
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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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Akiyama D, Katagiri N, Mizuno T, Tsukiya T, Takewa Y, Tatsumi E. Preclinical biocompatibility study of ultra-compact durable ECMO system in chronic animal experiments for 2 weeks. J Artif Organs 2020; 23:335-341. [PMID: 32514701 DOI: 10.1007/s10047-020-01180-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
Although the innovation has come in ECMO field, many problems remain unresolved. One of the main problems is about long-term durability and biocompatibility. Another is the system's size, weight, and its complicated equipment. For the former problem, we have previously developed ECMO system which consists of a tiny, hydrodynamically levitated centrifugal pump (BIOFLOAT-NCVC), a membrane oxygenator with hollow polyolefin fibers (BIOCUBE-NCVC), and the circuit treated with a heparin-bonding material (T-NCVC coating), and reported three cases of animal experiments for 30-day heparin-free drive. For the latter problem, we have integrated these elements to the compact system with sensors of temperature, pressure, and SvO2, and blood flow. Its installation area is 595 cm2, weighs 8.9 kg with attachable oxygen cassette, and battery which could last an hour at least. To evaluate the biocompatibility of this system, this ECMO was installed in four goats. Scheduled duration was 14 days. Heparin was continuously infused to control their ACT between 150 and 200 s except one 2-week experiment without systemic heparinization. All of the four goats survived till the scheduled termination. Function of the pump and the oxygenator during ECMO was stable. No obvious adverse events were observed. All lab data were of normal range after 1 week. Small infarctions were found at kidneys, but they were not clinically significant. No thrombus was found in the pump system. The oxygenators were extremely clean except a little thrombus formation; while, the heparin-free examination revealed acceptable cleanliness. The present study revealed good anti-thrombogenicity of this ultra-compact durable ECMO system with heparinization. Our system encourages awake and extubated management, rehabilitation, inter-hospital transfer, and prehospital initiation of ECMO.
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Affiliation(s)
- Daichi Akiyama
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan. .,Department of Cardiac Surgery, University of Tokyo Hospital, Tokyo, Japan.
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Yoshiaki Takewa
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Eisuke Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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Simonsen C, Magnusdottir SO, Andreasen JJ, Bleeg RC, Lie C, Kjærgaard B. Long-Distance Transportation of Carbon Monoxide-Poisoned Patients on Extracorporeal Membrane Oxygenation Seems Possible: A Porcine Feasibility Study. Air Med J 2019; 38:178-182. [PMID: 31122583 DOI: 10.1016/j.amj.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/08/2019] [Accepted: 03/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) has been widely used to stabilize patients with impairment of cardiac/respiratory function, and ECMO has been used to stabilize cardiopulmonary insufficiency caused by carbon monoxide (CO) poisoning in a porcine model. Airborne transportation in fixed wing aircraft of patients suffering from CO poisoning is challenging because as the air pressure drops, the oxygen content falls correspondingly. The aim of this study was to show the feasibility of cannulating and establishing ECMO therapy during airborne transportation after severe CO poisoning in a porcine model. METHODS An anesthetized pig was subjected to severe CO poisoning and loaded onto a Hercules aircraft. Cardiac arrest was induced at an altitude of 8,000 feet, after which cannulation and the establishment of venoarterial (VA) ECMO were performed. Vital signs were monitored, and arterial blood samples were analyzed while airborne. RESULTS CO poisoning was induced with carboxyhemoglobin at 58% before takeoff. We successfully cannulated the animal in-flight during cardiac arrest and initiated VA ECMO. The animal regained spontaneous circulation and was successfully weaned from ECMO. During VA ECMO, PaO2 was maintained at high levels (420-615 mm Hg). CONCLUSION It is possible to cannulate and initiate VA ECMO treatment as airborne en route therapy for cardiac arrest and severe CO intoxication in a porcine model.
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Affiliation(s)
- Carsten Simonsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aeromedical Evacuation Squadron 690, Royal Danish Air Force, Vadum, Denmark; Royal Danish Armed Forces Health Services, Brabrand, Denmark.
| | - Sigridur O Magnusdottir
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Biomedical Research Laboratory, Aalborg University Hospital North, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - René C Bleeg
- Aeromedical Evacuation Squadron 690, Royal Danish Air Force, Vadum, Denmark; Royal Danish Armed Forces Health Services, Brabrand, Denmark
| | - Claus Lie
- Aeromedical Evacuation Squadron 690, Royal Danish Air Force, Vadum, Denmark; Royal Danish Armed Forces Health Services, Brabrand, Denmark
| | - Benedict Kjærgaard
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Aeromedical Evacuation Squadron 690, Royal Danish Air Force, Vadum, Denmark; Royal Danish Armed Forces Health Services, Brabrand, Denmark; Biomedical Research Laboratory, Aalborg University Hospital North, Aalborg, Denmark
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Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20:1505-1535. [DOI: 10.1002/ejhf.1236] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Marco Metra
- Cardiology; University of Brescia; Brescia Italy
| | - Lars H. Lund
- Department of Medicine, Unit of Cardiology; Karolinska Institute; Stockholm Sweden
| | - Davor Milicic
- Department for Cardiovascular Diseases; University Hospital Center Zagreb, University of Zagreb; Zagreb Croatia
| | | | | | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Steven Tsui
- Transplant Unit; Royal Papworth Hospital; Cambridge UK
| | - Eduardo Barge-Caballero
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Nicolaas De Jonge
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center; Niguarda Hospital; Milan Italy
| | - Righab Hamdan
- Department of Cardiology; Beirut Cardiac Institute; Beirut Lebanon
| | - Tal Hasin
- Jesselson Integrated Heart Center; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin Hülsmann
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Aggeliki Gkouziouta
- Heart Failure and Transplant Unit; Onassis Cardiac Surgery Centre; Athens Greece
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; University of Heidelberg; Heidelberg Germany
| | - Arsen D. Ristic
- Department of Cardiology of the Clinical Center of Serbia; Belgrade University School of Medicine; Belgrade Serbia
| | | | | | - Petar Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center; Belgrade Serbia
| | - Frank Ruschitzka
- University Heart Center; University Hospital Zurich; Zurich Switzerland
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