Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Abstract

Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO(2) removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.

First application of a new portable, miniaturized system for extracorporeal membrane oxygenation

“…Therefore, intra-hospital ( Figure 2) and inter-hospital transport is greatly facilitated. Transfer of patients to specialized centers with ECMO support, who would otherwise be too unstable for transport, is becoming increasingly important 8 . With the new device, saturation of inflowing central venous blood, hemoglobin and hematocrit are recorded continuously.…”

Extracorporeal Membrane Oxygenation in Adults

“…Periferni V-A ECMO s malim kanilama koje se postave perkutanim putom, tzv. niskoprotočni vensko-arterijski ECMO, omogućuje vrlo brzi početak hemodinamske potpore u bolesnika u kardiorespiratornom arestu 17 .…”

“…This modality ensures predominantly circulatory support and is not used in patients with respiratory insufficiency 16 . Peripheral VA ECMO with small cannulae placed with a percutaneous approach, the so-called low-flow veno-arterial ECMO, allows very rapid initiation of hemodynamic support for patients in cardiorespiratory arrest 17 .…”

Kardiogener Schock

“…In zunehmenden Umfang sind auch "Hand-held-mini-ECMO"-Systeme (ECMO: "extracorporeal membrane oxygenation") verfügbar, die perkutan implantierbar und transportabel sind [40,41]. Sie eignen sich für die unmittelbare Erstversorgung hochinstabiler Patienten und/oder deren Transfer in ein spezialisiertes Zentrum.…”