Extracorporeal membrane oxygenator rescue and airborne transportation of patients with influenza A (H1N1) acute respiratory distress syndrome in a Mediterranean underserved area

Abstract

Adult respiratory distress syndrome (ARDS) secondary to H1N1 viral infection has been a worldwide medical and organizational challenge. We report our experience with extracorporeal membrane oxygenator (ECMO) rescue and transportation of patients with H1N1 ARDS within an insular and rural Mediterranean area of seven million inhabitants. A 24/7 on-call ECMO team was organized including one anesthesiologist, one cardiac surgeon, and one perfusionist. To limit missions' time to and from peripheral hospitals, airborne transportation with helicopter was the first choice. From November 2009 to January 2010, we performed 10 missions. Eight patients (80%) were placed on ECMO and transferred either on helicopter (70%) or with standard ambulance (10%). Average mission duration was nine hours (6-16 h). No complications secondary to the transportation means or to the ECMO were reported. Delivery of advanced medical technology can be achieved even in remote and underserved areas presenting geographical barriers. A multidisciplinary mobile ECMO team coordinated with adequate means of transportation could be routinely employed to rescue patients affected with other forms of severe acute hemodynamic and/or respiratory impairment.

Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: A case series

“…Jepson et al [23] demonstrated that with an experienced team, CT imaging of patients on ECMO can be performed safely, providing valuable information for subsequent management of patients. Recently, several ECMO centers also reported the feasibility of interhospital transfer on ECMO for patients with H1N1 [7,24,25]. We believe that the reduced weight and compact design of the portable miniaturized ECMO systems used by our center would have further contributed to the safe transport and handling of these unstable patients.…”

First experience with the deltastream® DP3 in venovenous extracorporeal membrane oxygenation and air-supported inter-hospital transport

“…In this context, airborne interhospital transport is possibly the most time-saving procedure within a certain distance. Despite its complexity, transporting patients on ECMO is described to be safe, if carried out by an experienced and skilled team [10][11][12][13][14][15]. At our hospital, we have managed to install a special ECMO team, which is integrated in the clinical routine operation but is available 24/7 in case of emergency [16].…”

Extracorporeal Gas Exchange for Acute Respiratory Failure in Adult Patients: A Systematic Review

“…Mortality rates ranged from 14 to 64% in the 16 studies from 11 countries reporting on the experience of ECMO for influenza A(H1N1)-associated ARDS (Tables 4 and 5) [15][16][17]33,[37][38][39][40][41][42][43][44][45][46][47][48]. The Australia and New Zealand collaborative group (ANZICS) was the first to report its experience [15].…”