Interhospital transport of the patient on extracorporeal cardiopulmonary support

Bennett, John B.; Hill, Jonathan G.; Long, William B.; Bruhn, Pamela S.; Haun, Michelle; Parsons, James A.

doi:10.1016/0003-4975(94)90375-1

Cited by 39 publications

(18 citation statements)

References 11 publications

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“…In our patient cohort, we observed no vessel perforation. Furthermore, the ischemic complication rate after arterial vessel access has been reported to be 18-70% in cases with percutaneous cardiopulmonary support via the femoral vessel (9,18). Eight (15%) of our patients developed temporary limb ischemia (PECLA [n = 2]; v-a ECMO [n = 6]) following placement of the arterial cannula.…”

Section: Discussionmentioning

confidence: 92%

“…It was often not possible to accommodate the flight crew, extracorporeal circulation specialists, and the physicians with the patient in a single vehicle. Despite providing a centrifugal pump and a membrane oxygenator for initiation of percutaneous cardiopulmonary support, there was no solution for transferring critically ill patients on cardiopulmonary bypass as one unit on a standard patient gurney (13,14). In 1999, Philipp developed a PECLA (iLA) system for treatment of severe hypercapnic respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we recommend the adjustment of the patient's blood pressure on the cardiopulmonary support system, because the left ventricular afterload is still determined by the blood pressure, and increasing the blood pressure will impair the emptying of a failing heart. A pulsatile flow pattern facilitates left ventricular unloading and reduces secondary risk of intracardiac clot formation (6,9). The femoro-femoral venoarterial access for ECMO support has some important limitations.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of transfer by helicopter, the flight altitude rarely exceeded 5000 ft, which made no extraordinary medical precautions necessary (9). During emergency medical services running on miniaturized extracorporeal gas exchange, we recommend that the loading and unloading procedure for air and ground ambulance transfer is strictly supervised by a crew member of the mobile ECMO team to avoid entanglement of the extracorporeal circuits.…”

Section: Safety Instructionsmentioning

confidence: 98%

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Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Arlt

Philipp²,

Zimmermann

et al. 2009

Artificial Organs

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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.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Safety Instructionsmentioning

confidence: 98%

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Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Arlt

Philipp²,

Zimmermann

et al. 2009

Artificial Organs

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“…Since the first report from Bennett about longterm survival of two among five adults with cardiopulmonary failure, who were transported with extracorporeal circulation system support in 1994, the number of ECMO transports has dramatically increased (5,15).…”

Section: Discussionmentioning

confidence: 99%

Comparison of a New Miniaturized Extracorporeal Membrane Oxygenation System With Integrated Rotary Blood Pump to a Standard System in a Porcine Model of Acute Lung Injury

et al. 2015

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Extracorporeal membrane oxygenation (ECMO) is used for severe acute respiratory distress syndrome. However, available ECMO systems are large and not well designed for fast delivery, emergency implantation, and interhospital transfer. Therefore, a new miniaturized oxygenator with integrated rotary blood pump (ILIAS) was developed and compared with a standard ECMO system in a large animal model. Acute lung injury was induced with repeated pulmonary saline lavage in 14 pigs until PaO2 /FiO2 -ratio was <100 mm Hg with a positive-end-expiratory-pressure of 5 mbar. Pigs were assigned to the following three groups: group 1 (n = 4): control group with conventional ventilation; group 2 (n = 5): standard vv-ECMO; group 3 (n = 5): vv-ILIAS. Gas exchange, hemodynamics, hemolysis, and coagulation activation were examined over a period of 8 h. No device failed during the observation period. PaCO2 decreased from 59.40 ± 4.14 mm Hg to 48.62 ± 4.50 mm Hg after 1 h in the ILIAS group compared with an improvement of PaCO2 from 48.86 ± 7.45 to 40.10 ± 6.02 in the conventional ECMO group (P = not significant [n.s.]). ARDS-induced respiratory acidosis was controlled promptly with a pH of 7.2 ± 0.1 at baseline increasing to 7.4 ± 0.1 in both study groups after 60 min of ECMO support. Mean carbon dioxide transfer was comparable between the conventional ECMO and ILIAS (211.36 ± 78.39 mL/min vs. 219.99 ± 76.72 mL/min, P = n.s.). PaO2 /FiO2 increased from 118.4 ± 15.5 mm Hg to 179.1 ± 72.4 mm Hg in the ILIAS group compared with an improvement of oxygenation from 107.1 ± 24.9 mm Hg to 179.0 ± 45.7 mm Hg in the standard ECMO group (P = n.s.). Mean oxygen transfer was calculated with 136.09 ± 30.25 mL/min for the ILIAS and 129.05 ± 36.28 mL/min for the standard ECMO. Hemodynamic instability or significant activation of the plasmatic coagulation was not observed. However, hemolysis was significantly higher in the ILIAS group compared with the conventional ECMO. As the ILIAS prototype provided excellent gas exchange with hemodynamic stability comparable with a standard ECMO system, we believe this study serves as a proof of concept. Further development and design modifications (optimized rotation speed and surface coating of rotor) are already done and another experiment is projected to reduce hemolysis and platelet consumption for clinical application.

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Round-the-Clock Operation: Trips and Tricks to Help Achieve Flexibility and Realizability

Gerfer

Sabashnikov

2023

ECMO Retrieval Program Foundation

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Interhospital transport of the patient on extracorporeal cardiopulmonary support

Cited by 39 publications

References 11 publications

Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Comparison of a New Miniaturized Extracorporeal Membrane Oxygenation System With Integrated Rotary Blood Pump to a Standard System in a Porcine Model of Acute Lung Injury

Round-the-Clock Operation: Trips and Tricks to Help Achieve Flexibility and Realizability

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