Extracorporeal membrane oxygenation for transport of hypoxaemic patients with severe ARDS.

Abstract

Conventional inter-hospital transfer of patients with severe acute respiratory distress syndrome (ARDS) in need of extracorporeal membrane oxygenation (ECMO) may be risky and in severe hypoxaemic patients may be associated with cerebral hypoxia and death. Therefore, we began a phase 1 study to evaluate the feasibility, complications and outcome of inter-hospital transport of these patients using veno-venous ECMO. Eight patients with severe ARDS and a PaO2/FIO2 < 6.7 kPa at a PEEP > or = 10 cm H2O were placed on a mobile ECMO at the referring hospital. The 495 (SD 123) km inter-hospital transport via a special ground ambulance took 341 (151) min. After transfer, blood-gas tensions were improved in spite of less optimal ventilator settings, compared with data before the start of ECMO. No significant complications occurred. Six patients survived and were discharged from hospital; two patients died because of multiple organ failure. We conclude that initiation of ECMO in hypoxaemic patients before inter-hospital transfer is feasible and enables safe transport to an ECMO centre.

A 22-year experience in global transport extracorporeal membrane oxygenation

“…Transport extracorporeal life support is a niche service that has been offered at 12 centers around the world to more than 600 individuals [1][2][3][4][5][6][7][8][9][10][11]. As opposed to EET, most facilities have developed an intrahospital transport ECMO capability to allow children to be moved short distances for emergent procedures such as computed tomography or cardiac catheterization [12].…”

“…Other transport ECMO centers have reported their experience with ECMO transport, but most of these have occurred within a radius limited to less than 1000 miles (1600 km) [5][6][7]9,10]. Haddad et al [22] described intercontinental transport of an adult with a left ventricular assist system and noted that the 21.5 hour trip required considerable cost and planning.…”

Inhaled Nitric Oxide to Improve Oxygenation for Safe Critical Care Transport of Adults With Severe Hypoxemia

“…When the p:F ratio cannot be maintained at more than 60 with other strategies for treatment of severe ARdS, then inhalation of nitric oxide is started by determining whether or not the patient responds to the inhaled gas. In iNO by AACN on May 10, 2018 http://ajcc.aacnjournals.org/ Downloaded from while receiving ECMO, 26 this practice necessitates a substantially increased workload related to the equipment required and also requires a physician to perform cannulation.…”

Extrakorporale Membranoxygenierung beim akuten Lungenversagen

“…Z. auf eine reine Rescuetherapie bei Patienten mit schwerstem ARDS, die entsprechend den schnellen Einschlusskriterien akut durch Hypoxie gefährdet sind und auf eine optimierte konservative Therapie nicht schnell genug reagieren (⊡ Tabelle 2).Die meisten Zentren folgen dabei einem klinischen Algorithmus (⊡ Abb.1) [18],der auch die Über-nahme von ARDS-Patienten aus anderen Krankenhäusern integriert. Bereits vor dem Transport erfolgt der Beginn der optimierten Therapie, die neben dem Einsatz optimierter Beatmungsregime und inhalativer Vasodilatatoren (inhaliertes Stickstoffmonoxid, Prostazyklin) unter Umständen sogar den Anschluss der ECMO vor dem Interhospitaltransport umfasst [29].…”