First experience with the new portable extracorporeal membrane oxygenation system Cardiohelp for severe respiratory failure in adults

Abstract

Background: Over the last decade, technical improvements in extracorporeal membrane oxygenation (ECMO) equipment have reduced procedure-related complications and have made ECMO an effective option for patients with acute respiratory distress syndrome (ARDS) if conventional therapy fails. Methods: In this report, we present our early experience with the Cardiohelp, a new portable miniaturized ECMO system, in 22 consecutive patients with ARDS. All patients were placed on venovenous ECMO. Cannulas were inserted percutaneously, employing the Seldinger technique. Data were collected prospectively. Results: The median patient age was 47 years (36 to 61). Fifteen patients from regional hospitals were too unstable for conventional transport and were placed on Cardiohelp at the referring hospital and then transported to our institution. The patients were transported by ambulance (n=2) or helicopter (n=13) over a distance of 50-250 km. Cardiohelp support resulted in immediate improvement of gas exchange and highly protective ventilation. The median duration of support was 13 days (8 to 19). An exchange of the device was necessary in 9 patients. Sixteen patients (72.7%) were successfully weaned from ECMO and fifteen patients (68.2%) survived. Device-related complications were not observed. Conclusions:The compact portable ECMO device Cardiohelp is a highly effective method to secure vital gas exchange and to reduce further ventilator-induced lung injury in patients with acute respiratory failure. Crucial technical innovations and ease of device transport and implantation allow location-independent stabilization with consecutive inter-hospital transfer.

Impact of Acute Kidney Injury on Outcome in Patients With Severe Acute Respiratory Failure Receiving Extracorporeal Membrane Oxygenation*

“…This included optimization of volume status and vasoactive agent requirements, lung-protective ventilation with low tidal volumes, moderate hypercapnia, high positive end-expiratory pressure (PEEP), the use of adjunctive therapeutic measures, such as prone position or nitric oxide, as well as treatment of the underlying disease in accordance with standard intensive care procedures (4,13). Patients from regional hospitals, who were potential candidates for ECMO, were transferred to our center.…”

“…For ground transport, a special intensive care transport vehicle was used. For air medical transport, a rescue helicopter was available (13,14).…”

Development of a new interfacility extracorporeal membrane oxygenation transport program for pediatric lung transplantation evaluation

“…The Cardiohelp TM machine has facilitated our team's development with implications that are worthy of mention. Since its release, centers using this miniaturized ECMO machine have produced a body of literature detailing its use in the transport setting (14)(15)(16)(17). In our experience the Cardiohelp TM has performed admirably with no mechanical complications to date.…”

The ICM research agenda on extracorporeal life support

“…Second, centrifugal pumps have permitted major improvements in efficacy and security over the older roller pumps, with less blood cell trauma, no requirement for venous reservoirs, and very few failures over weeks of support [635]. More recently, the continuing miniaturization of devices has permitted the integration of pump and oxygenator within one low weight device and has facilitated transport by mobile ECMO teams [36]. Lastly, sensors without direct blood contact to continuously measure pressures as well as hemoglobin and venous saturation are useful tools for enhanced circuit and patient safety.…”