Mobile cardio-respiratory support in prehospital emergency medicine.
BACKGROUND
Serious pulmonary and cardiac failure may be treated with extracorporeal membrane oxygenation (ECMO) when the conventional treatment fails. Improvements in extracorporeal circulation devices have allowed us to set up two specialized mobile units: a mobile cardiac assistance unit (MCAU) and a mobile respiratory assistance unit (MRAU). Their role is to provide ECMO at patient's bedside, and then to ensure inter-hospital transport (IHT). The aim of this study was to evaluate our experiences with the transportation of patients on ECMO.


METHODS
We performed two prospective observational studies, the first on IHT requiring MCAU during 3 years and the second on IHT requiring MRAU during 6 months.


RESULTS
Thirty-two patients needed MCAU. The median age is 40 years. The median distance travelled is 45 km. The median time of arrival at patient bedside is 49 min. Causes of cardiac shock were: myocarditis (28.1%), acute heart failure of unknown aetiology (21.9%), drug-induced cardiovascular failure (18.8%), post-infarction cardiac failure (12.5%), post-cardiac surgery (12.5%) and refractory cardiac arrest (6.2%). Thirty days mortality was 40%. Eleven patients needed MRAU. The median age was 33 years. The median distance travelled is 40 km; the median time of arrival at patient bedside is 47 min. All patients had severe acute respiratory distress syndrome complicating severe H1N1 virus infection. Thirty days mortality was 65%. In both the cases, all transportations were uneventful.


CONCLUSIONS
This study shows that mobile ECMO system can be successfully and quickly established at patient's bedside, and that transportation of patients on ECMO can be performed safely and without technical difficulties.
Chenaitia
Hichem
H
Department of Emergency Medicine and Intensive Care, Timone University Hospital, 264 rue St. Pierre, Marseille Cedex 5, France. chenaitiahichem@gmail.com
Massa
Horace
H
Toesca
Richard
R
Michelet
Pierre
P
Auffray
Jean-Pierre
JP
Gariboldi
Vlad
V
D000328:Adult; D000552:Ambulances; D015331:Cohort Studies; D004630:Emergencies; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000295:instrumentation* / Q000379:methods; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005602:France; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D016019:Survival Analysis; D014187:Transportation of Patients; D016896:Treatment Outcome