title: Extracorporeal circulatory systems in the interhospital transfer of critically ill patients: experience of a single institution.
abstract: OBJECTIVE
  Critically ill patients with acute circulatory failure cannot be moved to other institutions unless stabilized by mechanical support systems. Extracorporeal heart and lung assist systems are increasingly used as a bridge to end-organ recovery or transplantation, and as an ultimate rescue tool in cardiopulmonary resuscitation.
  
  
  METHODS
  From July 2001 to April 2008, we had 38 requests for extracorporeal support for interhospital transfer carried out by the air medical service. Respiratory failure was present in 29 patients, who were provided with pumpless extracorporeal lung assist (PECLA) or veno-venous extracorporeal membrane oxygenation (ECMO). Cardiac failure dominated in 9 patients, who underwent implantation of extracorporeal life support (ECLS). Underlying diseases were acute respiratory distress syndrome in 15 patients, pneumonia in 7, prior lung transplant status in 4, cardiogenic shock in 7, and septic shock in 4.
  
  
  RESULTS
  All assist systems were connected via peripheral vessels by the Seldinger technique. Transport was uneventful in all cases with no technical failures. On arrival at the specialized care hospital, two patients had leg ischemia and underwent relocation of the arterial cannula. After a mean (SD) support of 5.1 (3.0) days for PECLA, 3.5 (2.9) days for ECLS, and 7.3 (5.8) days for ECMO, 60%, 66%, and 66% of patients, respectively, could be successfully weaned from the systems. Discharge rates were 45% for PECLA, 44% for ECLS, and 56% for ECMO.
  
  
  CONCLUSIONS
  Our experience proves that minimized extracorporeal assist devices allow safe assistance of patients with isolated or combined heart and lung failure in need of interhospital transfer. Critically ill patients get a chance to reach a center of maximum medical care.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany. assadhaneya@web.de
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Maik
authors.initials: M
authors.lastname: Foltan
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Thomas
authors.initials: T
authors.lastname: Puehler
authors.forename: Stephan
authors.initials: S
authors.lastname: Hirt
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kobuch
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Matthias
authors.initials: M
authors.lastname: Arlt