Ten thousand kilometre transfer of cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation for emergency heart transplantation: Cooperation between Reunion Island and Metropolitan France

Charon, Clément; Allyn, Jérôme; Bouchet, Bruno; Nativel, Fréderic; Braunberger, Éric; Brulliard, Caroline; Martinet, Olivier; Allou, Nicolas

doi:10.1177/2048872617719652

Cited by 10 publications

(12 citation statements)

References 14 publications

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“…A protocol for the immediate management and safe transfer of unstable patients in cardiogenic shock must be developed and available at each tertiary hub centre, both for de novo patients and those with chronic, deteriorating heart failure. This protocol must be individualized, taking into account geographical considerations and resource availability at each spoke, including in some cases a team dispatched from the tertiary hub centre to retrieve the patient …”

Section: Organizational Issues For Patient Referral To Advanced Heartmentioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

677

605

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This article updates the Heart Failure Association of the European Society of Cardiology (ESC) 2007 classification of advanced heart failure and describes new diagnostic and treatment options for these patients. Recognizing the patient with advanced heart failure is critical to facilitate timely referral to advanced heart failure centres. Unplanned visits for heart failure decompensation, malignant arrhythmias, co-morbidities, and the 2016 ESC guidelines criteria for the diagnosis of heart failure with preserved ejection fraction are included in this updated definition. Standard treatment is, by definition, insufficient in these patients. Inotropic therapy may be used as a bridge strategy, but it is only a palliative measure when used on its own, because of the lack of outcomes data. Major progress has occurred with short-term mechanical circulatory support devices for immediate management of cardiogenic shock and long-term mechanical circulatory support for either a bridge to transplantation or as destination therapy. Heart transplantation remains the treatment of choice for patients without contraindications. Some patients will not be candidates for advanced heart failure therapies. For these patients, who are often elderly with multiple co-morbidities, management of advanced heart failure to reduce symptoms and improve quality of life should be emphasized. Robust evidence from prospective studies is lacking for most therapies for advanced heart failure. There is an urgent need to develop evidence-based treatment algorithms to prolong life when possible and in accordance with patient preferences, increase life quality, and reduce the burden of hospitalization in this vulnerable patient population.

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Section: Organizational Issues For Patient Referral To Advanced Heartmentioning

confidence: 99%

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Crespo-Leiro

Metra

Lund

et al. 2018

European J of Heart Fail

677

605

View full text Add to dashboard Cite

show abstract

“…No existen estudios prospectivos exclusivamente de transporte de pacientes con shock cardiogénico. Son a destacar los estudios retrospectivos realizados en islas francesas donde se analizan transportes en ECMO VA de largas distancias (136km-10.000 km) a los centros de trasplante cardiaco (32,42,43). En el estudio más reciente, de los pacientes a evacuar el 57,6% lo hizo con ECMO-VA y con balón de contrapulsación asociado en el 78,6% de ellos.…”

Section: Criterios De Ecmo Para Traslado En El Shock Cardiogénicounclassified

“…En el estudio más reciente, de los pacientes a evacuar el 57,6% lo hizo con ECMO-VA y con balón de contrapulsación asociado en el 78,6% de ellos. Los pacientes trasladados con soporte circulatorio, presentaron supervivencias similares a aquellos en los que la ECMO se instauraba en el hospital de referencia (36,8% vs 37%) y con resultados post-trasplante cardiaco similares a aquellos que fueron transportados sin soporte circulatorio (85,7%-83,3%), pese a la mayor gravedad de estos primeros (43). En cuanto a las asistencias ventriculares (VAD) permiten un soporte hemodinámico completo a medio plazo como puente al trasplante cardiaco (20).…”

Section: Criterios De Ecmo Para Traslado En El Shock Cardiogénicounclassified

“…Existen en el mercado, botellas de oxígeno medicinal con pantalla digital informando del tiempo disponible sin necesidad de realizar cálculos con el manómetro. PLANIFICACIÓN DEL TRASLADO Los problemas de logística suelen conllevar aumento del tiempo de traslado y riesgos, documentándose aumento de las infecciones nosocomiales y más efectos adversos durante los traslados de largas distancias (29,43). Por ello, el trabajo de sistematizar el transporte puede ayudar a mejorar los resultados.…”

Section: Equipamiento Y Preparación Del Trasladounclassified

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Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation

Burgueño

González

Sarralde

et al. 2019

Medicina Intensiva (English Edition)

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Extracorporeal membrane oxygenation (ECMO) support is indicated for patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. The practitioner's experience and quantity of necessary resources are reasons why regionalization could benefit these types of patients, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and interterritorial approach. ECMO transportation is safer than without mechanical support, although there are currently no criteria for starting the therapy on patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of the transfer can improve results. There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes, data that could help with the indication and management of this type of transportation.

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“…A report on the successful transfer of cardiogenic shock patients using an air lift demonstrates the feasibility of very long-distance medical evacuation of cardiogenic shock patients on VA-ECMO for emergency heart transplantation, with acceptable long-term results. 16 At the end of this issue an educational review paper is published on the diagnosis and management of diuretic resistance in acute heart failure. 17…”

mentioning

confidence: 99%

Focus on acute heart failure: prehospital diagnosis, ultrasound examination and monitoring, pathophysiology, diuretic resistance

Vrints

2018

European Heart Journal: Acute Cardiovascular Care

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Ten thousand kilometre transfer of cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation for emergency heart transplantation: Cooperation between Reunion Island and Metropolitan France

Abstract: This study suggests the feasibility of very long-distance medical evacuation of cardiogenic shock patients on VA-ECMO for emergency heart transplantation, with acceptable long-term results.

Cited by 10 publications

References 14 publications

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology

Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation

Focus on acute heart failure: prehospital diagnosis, ultrasound examination and monitoring, pathophysiology, diuretic resistance

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