title: Extracorporeal membrane oxygenator rescue and airborne transportation of patients with influenza A (H1N1) acute respiratory distress syndrome in a Mediterranean underserved area.
abstract: Adult respiratory distress syndrome (ARDS) secondary to H1N1 viral infection has been a worldwide medical and organizational challenge. We report our experience with extracorporeal membrane oxygenator (ECMO) rescue and transportation of patients with H1N1 ARDS within an insular and rural Mediterranean area of seven million inhabitants. A 24/7 on-call ECMO team was organized including one anesthesiologist, one cardiac surgeon, and one perfusionist. To limit missions' time to and from peripheral hospitals, airborne transportation with helicopter was the first choice. From November 2009 to January 2010, we performed 10 missions. Eight patients (80%) were placed on ECMO and transferred either on helicopter (70%) or with standard ambulance (10%). Average mission duration was nine hours (6-16 h). No complications secondary to the transportation means or to the ECMO were reported. Delivery of advanced medical technology can be achieved even in remote and underserved areas presenting geographical barriers. A multidisciplinary mobile ECMO team coordinated with adequate means of transportation could be routinely employed to rescue patients affected with other forms of severe acute hemodynamic and/or respiratory impairment.
authors: Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy. gdancona@ismett.edu
authors: Giuseppe
authors: G
authors: D'Ancona
authors: Guido
authors: G
authors: Capitanio
authors: Giuseppe
authors: G
authors: Chiaramonte
authors: Roberto
authors: R
authors: Serretta
authors: Marco
authors: M
authors: Turrisi
authors: Michele
authors: M
authors: Pilato
authors: Antonio
authors: A
authors: Arcadipane
mesh_terms: D000328:Adult; D017732:Air Ambulances / Q000458:organization & administration; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000472:pathogenicity*; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology / Q000628:therapy* / Q000821:virology; D007558:Italy; D008297:Male; D008507:Medically Underserved Area; D019083:Mediterranean Region; D008875:Middle Aged; D009937:Organizational Objectives; D058873:Pandemics; D010348:Patient Care Team / Q000458:organization & administration; D012040:Regional Health Planning / Q000458:organization & administration; D012128:Respiratory Distress Syndrome / Q000628:therapy* / Q000821:virology; D012424:Rural Population; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult