title: Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock.
abstract: OBJECTIVE
  Cardiogenic shock is associated with mortality rates up to 70%, even if patients are treated with intensive care support or thrombolytic therapy. Early coronary revascularisation can be life-saving but it is oftentimes not available at the hospital to which the patient was initially taken. Up to now, transferring patients in a state of severe cardiogenic shock and/or cardiopulmonary resuscitation is mostly decided to be impossible. We report on the use of two newly developed minimised systems for hand-held-extracorporeal membrane oxygenation (ECMO) (ELS-System™ and CARDIOHELP™, both from MAQUET Cardiopulmonary AG, Germany), which we have used for rapid extracorporeal life support and interhospital transfer on Mini-ECMO. We characterise the emergency use, safety instructions and bridging function of these novel Mini-ECMO devices.
  
  
  METHODS
  Between June 2007 and August 2010, we administered percutaneous Mini-ECMO support to 21 adult cardiogenic shock patients. The main components of each Mini-ECMO system are a centrifugal pump and a membrane oxygenator. The systems can act independently from wall connection points, and are they are small enough to be attached nearby a patient's side during transport.
  
  
  RESULTS
  On ECMO, gas exchange improved significantly, vasopressor support could be significantly marked down and signs of shock disappeared in all patients. Emergency medical service was carried out in re-established blood-flow and oxygen delivery. The patients were bridged to coronary artery bypass grafting (CABG) (n = 6), ventricular assist device (n = 1) or pulmonary embolectomy (n=1) or specialised intensive care (n=13). Thirteen patients (62%) had completely recovered.
  
  
  CONCLUSIONS
  The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients.
authors.affiliation: University Hospital Regensburg, Regensburg, Germany. matthias.arlt@klinik.uni-regensburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Arlt
authors.forename: Alois
authors.initials: A
authors.lastname: Philipp
authors.forename: Sabine
authors.initials: S
authors.lastname: Voelkel
authors.forename: Daniele
authors.initials: D
authors.lastname: Camboni
authors.forename: Leopold
authors.initials: L
authors.lastname: Rupprecht
authors.forename: Bernhard-Martin
authors.initials: BM
authors.lastname: Graf
authors.forename: Christof
authors.initials: C
authors.lastname: Schmid
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
mesh_terms: D000328:Adult; D000368:Aged; D004630:Emergencies; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult