title: Extracorporeal life support for management of refractory cardiac or respiratory failure: initial experience in a tertiary centre.
abstract: BACKGROUND
  Extracorporeal Life Support (ECLS) and extracorporeal membrane oxygenation (ECMO) have been indicated as treatment for acute respiratory and/or cardiac failure. Here we describe our first year experience of in-hospital ECLS activity, the operative algorithm and the protocol for centralization of adult patients from district hospitals.
  
  
  METHODS
  At a tertiary referral trauma center (Careggi Teaching Hospital, Florence, Italy), an ECLS program was developed from 2008 by the Emergency Department and Heart and Vessel Department ICUs. The ECLS team consists of an intensivist, a cardiac surgeon, a cardiologist and a perfusionist, all trained in ECLS technique. ECMO support was applied in case of severe acute respiratory distress syndrome (ARDS) not responsive to conventional treatments. The use of veno-arterial (V-A) ECLS for cardiac support was reserved for cases of cardiac shock refractory to standard treatment and cardiac arrests not responding to conventional resuscitation.
  
  
  RESULTS
  A total of 21 patients were treated with ECLS during the first year of activity. Among them, 13 received ECMO for ARDS (5 H1N1-virus related), with a 62% survival. In one case of post-traumatic ARDS, V-A ECLS support permitted multiple organ donation after cerebral death was confirmed. Patients treated with V-A ECLS due to cardiogenic shock (N = 4) had a survival rate of 50%. No patients on V-A ECLS support after cardiac arrest survived (N = 4).
  
  
  CONCLUSIONS
  In our centre, an ECLS Service was instituted over a relatively limited period of time. A strict collaboration between different specialists can be regarded as a key feature to efficiently implement the process.
authors.affiliation: Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cianchi
authors.forename: Simona
authors.initials: S
authors.lastname: Biondi
authors.forename: Manuela
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Pasquini
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.forename: Marco
authors.initials: M
authors.lastname: Ciapetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.forename: Simona
authors.initials: S
authors.lastname: Bacci
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bernardo
authors.forename: Erminia
authors.initials: E
authors.lastname: Mascitelli
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D057209:Hospital Rapid Response Team; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult