[Interhospital transport of patients requiring extracorporeal membrane oxygenation ECMO].
BACKGROUND
The recent outbreak of AH1N1 influenza was associated with an increased number of respiratory complications. There were some extremely severe cases of ARDS, in which conventional therapy could not secure adequate gas exchange. These patients fulfilled ECMO criteria, however, due to late referral, were not suitable for transportation. To solve this problem, a portable ECMO system, providing for safe management of these patients, has been introduced in our institution.


METHODS
We reviewed five adult ARDS patients, who were transported by an ambulance for a distance ranging from 2 to 95 km, over 35 to 120 min. In four cases, a veno-venous ECMO system was used, and one patient had an arterio-venous circuit. All circuits were implanted before transportation by a dedicated team from the reference hospital, comprising an anaesthesiologist, a cardiac surgeon and a perfusionist. All transportations were successful and no complications and/or technical problems were observed. During the subsequent ITU treatment, three patients survived and two died (one because of uncontrollable bleeding from the ECMO cannula, and one because of sepsis and multiple organ failure).


CONCLUSIONS
We conclude that safe use of ECMO during transportation is possible, and does not require very sophisticated and expensive equipment. A standard ambulance is sufficient for the purpose.
Department of Cardiac Anaesthesia and Intensive Therapy, Medical University of Silesia, Silesian Centre for Heart Diseases in Zabrze, ul. M.Curie-Skłodowskiej 9, 41-800 Zabrze. kardanest@sum.edu.pl
Piotr
P
Knapik
Roman
R
Przybylski
Jarosław
J
Borkowski
Rafał
R
Koba
Dawid
D
Borowik
Tomasz
T
Maciejewski
Marcin
M
Borowicz
Grzegorz
G
Włoczka
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000379:methods*; D011044:Poland; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*; D014187:Transportation of Patients / Q000379:methods*; D016896:Treatment Outcome